Objectives: The purpose of our study was to investigate medical care utilization behavior and the conceptions of disease treatment among spine disease patients.Summary of Literature Review: Analyzing the medical care utilization behavior and conceptions of disease treatment among spine disease patients is important. Materials and Methods: A survey was administered to 500 first-time patients who visited the spine center of a tertiary educational hospital from May 2017 to August 2019. Results: A total of 479 valid responses were analyzed. A minority of patients (16.1%) visited the tertiary educational hospital without having previously visited a private hospital. Spinal procedures and surgery were considered negatively by 52.6% of respondents, and 14.8% of patients reported negative perceptions of orthopedic drugs. Conclusions Extensive efforts will be required to improve unreasonable medical utilization behavior by changing patients’ incorrect knowledge and beliefs about hospitals, diseases, and treatments.

BACKGROUND AND OBJECTIVES: Ten to twenty percent of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) treatment. If untreated, approximately 15% to 25% of KD patients have complications. The aim of this study was to find useful predictors of responsiveness to initial IVIG treatment in KD. SUBJECTS AND METHODS: We retrospectively reviewed medical records of 91 children diagnosed with KD at Myong Ji Hospital from March 2012 to April 2014. Before and after (24 hours to 36 hours) IVIG treatment, the following laboratory data were obtained: hemoglobin (Hb) level, white blood cell count, proportion of neutrophil, lymphocyte and eosinophil, platelet count, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), creatine kinase (CK), creatine kinase MB (CK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP). Subjects were then divided into two groups: IVIG-responsive or IVIG-resistant. RESULTS: Of 91 patients, 11 (12%) required retreatment. By univariate analysis, before-IVIG laboratory parameters of white blood cell count, % neutrophil, ERS, CRP, sodium, CK, CK-MB, and NT-proBNP were significantly different between IVIG-responsive and IVIG-resistant patient groups. In the after-IVIG laboratory parameters, Hb level, white blood cell count, % neutrophil, % lymphocyte, CRP, CK, CK-MB, and NT-pro-BNP were significantly different between the two groups. While the mean-differences were not statistically significant, fractional change (FC)-CRP and FC-% neutrophil showed significant difference. By multivariate analysis, FC-CRP was confirmed to be an independent predictor for initial IVIG resistance. CONCLUSION: Fractional change-C-reactive protein might be a useful and important value for predicting initial IVIG resistance in KD patients.
Blood Sedimentation ; C-Reactive Protein ; Child ; Creatine Kinase ; Eosinophils ; Humans ; Immunization, Passive* ; Immunoglobulins ; Immunoglobulins, Intravenous ; Leukocyte Count ; Lymphocytes ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Multivariate Analysis ; Neutrophils ; Platelet Count ; Retreatment ; Retrospective Studies ; Risk Factors ; Sodium

Protein arginine methylation is important for a variety of cellular processes including transcriptional regulation, mRNA splicing, DNA repair, nuclear/cytoplasmic shuttling and various signal transduction pathways. However, the role of arginine methylation in protein biosynthesis and the extracellular signals that control arginine methylation are not fully understood. Basic fibroblast growth factor (bFGF) has been identified as a potent stimulator of myofibroblast dedifferentiation into fibroblasts. We demonstrated that symmetric arginine dimethylation of eukaryotic elongation factor 2 (eEF2) is induced by bFGF without the change in the expression level of eEF2 in mouse embryo fibroblast NIH3T3 cells. The eEF2 methylation is preceded by ras-raf-mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase (ERK1/2)-p21(Cip/WAF1) activation, and suppressed by the mitogen-activated protein kinase (MAPK) inhibitor PD98059 and p21(Cip/WAF1) short interfering RNA (siRNA). We determined that protein arginine methyltransferase 7 (PRMT7) is responsible for the methylation, and that PRMT5 acts as a coordinator. Collectively, we demonstrated that eEF2, a key factor involved in protein translational elongation is symmetrically arginine-methylated in a reversible manner, being regulated by bFGF through MAPK signaling pathway.
Animals ; Arginine ; Cell Dedifferentiation ; Cyclin-Dependent Kinase Inhibitor p21/genetics/metabolism ; Elongation Factor 2 Kinase/*metabolism ; Fibroblast Growth Factor 2/*metabolism ; Fibroblasts/*metabolism/pathology ; Flavonoids/pharmacology ; MAP Kinase Signaling System/drug effects/genetics ; Methylation ; Mice ; Mitogen-Activated Protein Kinases/antagonists & inhibitors ; Myofibroblasts/pathology ; NIH 3T3 Cells ; Protein Methyltransferases/*metabolism ; Protein-Arginine N-Methyltransferases/*metabolism ; RNA, Small Interfering/genetics

Protein arginine methylation is important for a variety of cellular processes including transcriptional regulation, mRNA splicing, DNA repair, nuclear/cytoplasmic shuttling and various signal transduction pathways. However, the role of arginine methylation in protein biosynthesis and the extracellular signals that control arginine methylation are not fully understood. Basic fibroblast growth factor (bFGF) has been identified as a potent stimulator of myofibroblast dedifferentiation into fibroblasts. We demonstrated that symmetric arginine dimethylation of eukaryotic elongation factor 2 (eEF2) is induced by bFGF without the change in the expression level of eEF2 in mouse embryo fibroblast NIH3T3 cells. The eEF2 methylation is preceded by ras-raf-mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase (ERK1/2)-p21(Cip/WAF1) activation, and suppressed by the mitogen-activated protein kinase (MAPK) inhibitor PD98059 and p21(Cip/WAF1) short interfering RNA (siRNA). We determined that protein arginine methyltransferase 7 (PRMT7) is responsible for the methylation, and that PRMT5 acts as a coordinator. Collectively, we demonstrated that eEF2, a key factor involved in protein translational elongation is symmetrically arginine-methylated in a reversible manner, being regulated by bFGF through MAPK signaling pathway.
Animals ; Arginine ; Cell Dedifferentiation ; Cyclin-Dependent Kinase Inhibitor p21/genetics/metabolism ; Elongation Factor 2 Kinase/*metabolism ; Fibroblast Growth Factor 2/*metabolism ; Fibroblasts/*metabolism/pathology ; Flavonoids/pharmacology ; MAP Kinase Signaling System/drug effects/genetics ; Methylation ; Mice ; Mitogen-Activated Protein Kinases/antagonists & inhibitors ; Myofibroblasts/pathology ; NIH 3T3 Cells ; Protein Methyltransferases/*metabolism ; Protein-Arginine N-Methyltransferases/*metabolism ; RNA, Small Interfering/genetics

Sialadenoma papilliferum (SP) is a rare benign neoplasm that normally arises from the minor salivary glands, particularly in the palate. SP is normally encountered in older men with an exophytic papillary surface growth. In the present study, an SP of the hard palate of a 69-year-old woman was examined immunohistochemically. Myoepithelial cell markers, such as S-100, smooth muscle actin and vimentin, were observed in the basal or luminal layer of tumor cells, indicating that myoepithelial cells participate in the pathogenesis of SP. In addition, cytokeratin 7 was also strongly detected in the tumor cells, suggesting that excretory ductal epithelial cells have a role in its histogenesis. A review of the literature of immunohistochemical studies on SP showed that the expression and co-expression of cytokeratins and myoepithelial cell markers have been reported in tumor cells. These results suggested that excretory duct cells and myoepithelial cells participate in the pathogenesis of SP.
Actins ; Aged ; Epithelial Cells ; Female ; Humans ; Immunohistochemistry ; Keratin-7 ; Keratins ; Male ; Muscle, Smooth ; Palate ; Palate, Hard ; Phenobarbital ; Salivary Glands, Minor ; Vimentin

BACKGROUND/AIMS: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis. METHODS: We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months. RESULTS: Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84). CONCLUSIONS: Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.
Adult ; Aged ; Area Under Curve ; Cohort Studies ; Female ; Hepatic Veins/*physiopathology ; Humans ; Liver Cirrhosis/diagnosis/*mortality/physiopathology ; Liver Failure/diagnosis/*mortality/physiopathology ; Male ; Middle Aged ; Models, Biological ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Regression Analysis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Venous Pressure

Peroral cholagioscopy is a good procedure that permits direct visualization of the biliary tree and target biopsies of lesions. However, peroral cholangioscopy with a mother-baby system requires two experienced endoscopists, and the procedure remains time consuming and expensive and the apparatus is easily broken. Therefore, an easier technique to get direct visual examination of the biliary tree is needed. Direct peroral cholangioscopy (direct POC) with using an ultra-slim upper endoscope was performed in two patients after endoscopic stone removal for diagnosing their biliary stricture. One patient had wire-guided direct POC performed and the patient was diagnosed benign biliary stricture on the proximal CBD after forcep biopsy. Another patient had overtube-assisted direct POC performed and that patient was found to have a polypoid lesion at the bifurcation. Future advances in endoscope development, as well as specifically designed accessories, are expected to increase its clinical utility.
Biliary Tract ; Biopsy ; Constriction, Pathologic ; Endoscopes* ; Humans ; Surgical Instruments

A metastatic melanoma to the gastrointestinal tract is observed in 1.5~4.4% of all melanoma patients. However, colonic and rectal involvement is less common. A 72-year-old woman was admitted due to abdominal pain and poor oral intake for 20 days. She had a 3 x 4 cm-sized mass on her right inguinal area 4 month ago, which was diagnosed as a malignant melanoma of the inguinal lymph node on excision biopsy. A large exophytic mass with an irregular ulcerlated, whitish patch, erythematous surface was observed in the hepatic flexure during colonoscopy. A histology diagnosis of a metastatic melanoma was made by an optical microscopy examination of the biopsies obtained during the colonscopy, and palliative right hemicolectomy was performed on account of a potential intestinal obstruction. We report a case of a metastatic melanoma of the colon with a review of the relevant literature.
Abdominal Pain ; Aged ; Biopsy ; Colon* ; Colonoscopy ; Diagnosis ; Female ; Gastrointestinal Tract ; Humans ; Intestinal Obstruction ; Lymph Nodes ; Melanoma* ; Microscopy

Macroglobulinemia is the result of an uncontrolled proliferation of lymphocytes and plasma cells in which a large IgM M protein is produced. IgM monoclonal gammopathy is recognized in a variety of lymphoproliferative diseases and Waldenstr?m's macroglobulinemia (WM) is the most frequent disease in this group. We report a case of nodal marginal zone B-cell lymphoma (Nodal MZBCL) accompanied by monoclonal macroglobulinemia. A 58-year-old man was admitted to the hospital with chronic fatigue and dyspnea. Physical examination revealed cervical, subaxillary, and inguinal lymphadenopathy. Histopathologically, monocytoid B cells with abundant pale cytoplasm and small nuclei infiltrated the cervical lymph node. The neoplastic cells were positive for CD 20, bcl-2, and IgM. The serum and urine electrophoresis showed monoclonal spike in the globulin region and immunoelectrophoresis demonstrated immunoglobulin of IgM, kappa type. Immunohistochemically, this monoclonal gammaglobulinemia (IgM, Kappa) was produced and secreted from the nodal MZBCL. This is the first report of nodal MZBCL accompanying macroglobulinemia in Korea.
B-Lymphocytes ; Cytoplasm ; Dyspnea ; Electrophoresis ; Fatigue ; Humans ; Immunoelectrophoresis ; Immunoglobulin M ; Immunoglobulins ; Korea ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Lymphoma, B-Cell, Marginal Zone* ; Middle Aged ; Paraproteinemias ; Physical Examination ; Plasma Cells ; Waldenstrom Macroglobulinemia*