BACKGROUND: Rheumatoid arthritis (RA) is characterized by chronic inflammation and joint damage. Methotrexate (MTX), a commonly used disease-modifying anti-rheumatic drug (DMARD) used in RA treatment. However, the continued use of DMARDs can cause adverse effects and result in limited therapeutic efficacy. Cartilage extracellular matrix (CECM) has anti-inflammatory and anti-vascular effects and promotes stem cell migration, adhesion, and differentiation into cartilage cells. METHODS: CECM was assessed the dsDNA, glycosaminoglycan, collagen contents and FT-IR spectrum of CECM.Furthermore, we determined the effects of CECM and MTX on cytocompatibility in the SW 982 cells and RAW 264.7 cells. The anti-inflammatory effects of CECM and MTX were assessed using macrophage cells. Finally, we examined the in vivo effects of CECM in combination with MTX on anti-inflammation control and cartilage degradation in collageninduced arthritis model. Anti-inflammation control and cartilage degradation were assessed by measuring the serum levels of RA-related cytokines and histology. RESULTS: CECM in combination with MTX had no effect on SW 982, effectively suppressing only RAW 264.7 activity.Moreover, anti-inflammatory effects were enhanced when low-dose MTX was combined with CECM. In a collageninduced arthritis model, low-dose MTX combined with CECM remarkably reduced RA-related and pro-inflammatory cytokine levels in the blood. Additionally, low-dose MTX combined with CECM exerted the best cartilage-preservation effects compared to those observed in the other therapy groups. CONCLUSION Using CECM as an adjuvant in RA treatment can augment the therapeutic effects of MTX, reduce existing drug adverse effects, and promote joint tissue regeneration.

BACKGROUND: Eye irritation tests with animals have been conducted for a long time. However, the subjective decision to irritation, the anatomic/physiologic difference between species and humans, and ethical issues are crucial problems. Various research groups have paid attention to alternative testing methods. In these senses, we fabricated in vitro minicornea models with immortalized human corneal epithelial cells (iHCECs) and keratocytes (iHCKs) and used them for irritation tests. This study hypothesized that our mini-cornea model could present different viability tendencies according to test chemicals with different irritancy levels. METHODS: Cells used in this study were characterized with cornea-specific markers by immunocytochemistry and western blot. To make a three-dimensional hemisphere construct like cornea stroma, we cultured iHCKs under modified culture conditions verified by matrix formation and total collagen content. iHCECs were seeded on the construct and cultured at an air–liquid interface. The model was treated with 2-phenoxyethanol, triton X-100, sodium lauryl sulfate, and benzalkonium chloride. RESULTS: iHCECs and iHCKs presented their specific cell markers. In modifying the culture condition, the group treating ascorbic acid (200 lg/ml) presented an intact cellular matrix and included the highest collagen content; thus, we used this condition to fabricate the mini-cornea model. The model shows hemisphere shape and homogenous cell distributions in histological analysis. We observed different sensitivity tendencies by types of chemicals, and the model’s viability significantly decreased when the chemical concentration increased. CONCLUSION In this study, we performed and observed irritation tests using a tissue-engineered mini-cornea model and considered to apply as an alternative approach for animal tests.

In this study, the Ti6Al4V specimens were fabricated using selective laser melting (SLM) method (Ti6Al4V-AS group). These specimens were performed to heat treatment at 950℃ and 550℃ using vacuum electric furnace (Ti6Al4V-HT group). The mechanical properties, metallographic shape, crystalline structure, and chemical compositions of the alloy specimens before and after heat treatment were analyzed. The Ti6Al4V-AS group showed ultimate tensile strength (UTS) and low elongation values. Acicular crystal grains were observed in metallographic image and the α'-Ti phase was dominant. After heat treatment (Ti6Al4V-HT group), the UTS was lowered and the elongation was increased. In addition, a lamellar structure in which columnar crystal grains are arranged was observed, α+β-Ti phase was formed, and crystallinity increased. As a result of analyzing the chemical composition, the Ti6Al4V-AS specimen contained a higher carbon content than the Ti6Al4V-HT specimen. This high carbon content could be related to the formation of α'-phase, high strength and low elongation of the Ti6Al4V-AS specimen. Ti6Al4V-HT specimen showed that the overall carbon content was low, but the carbon content was locally high in the α-Ti phase region. Therefore, it is necessary to control effectively the incorporation of carbon gas in the production of Ti6Al4V specimens using SLM.

Objective: This study analyzed the characteristics of people who attempted suicide that resulted in deaths as compared to that of the suicide survivors. Methods: This study included 799 suicide attempts that occurred from March 1, 2015, to March 31, 2019 at the emergency department of the university hospital in a city of around 300,000 people. Suicide attempts were classified into the survivor and death groups, and the characteristics of each group were compared. The suicide deaths due to re-attempts were also analyzed. Results: There were more males than females in the death groups. There was a high proportion of people aged 50 or older in the death groups. Hanging, carbon monoxide poisoning, and jumping from great heights were the most commonly used methods of suicide in the death groups. In the selected death group, psychiatric symptom, physical illness, and economic problem among the suicidal causes and depressive disorder among the psychiatric diagnoses were factors that increase the risk of suicide death. Sixty-three point four percent of the survival groups and 52.5% of the selected deaths had not received psychiatric care. On the analysis of suicide deaths due to re-attempts, the average number of suicide attempts was 2.45±0.9. The time from the first suicide attempt to the last suicide attempt was 13.8±10.4 months. Conclusion If it is necessary to make a treatment decision for a suicide attempt in a limited time, such as the case of treating a suicide attempter who visits an emergency department, it is necessary to consider the characteristic factors of the death attempts of suicidal people.

PURPOSE: Adventitial cystic disease (ACD) is a rare condition that causes intermittent claudication and non-atherosclerotic disease without cardiovascular risk factors. The etiology and optimal treatment of ACD remain controversial. The purpose of this study was to analyze surgical treatment results for ACD and to elucidate optimal treatment options.MATERIALS AND METHODS: We retrospectively reviewed 30 patients with ACD who underwent surgery from 2006 to 2018. Twenty-two patients had arterial ACD, six had venous ACD, and two had combined venous and arterial ACD. We reviewed demographic and clinical characteristics, treatment details, and procedure outcomes.RESULTS: Recurrence occurred in 6 cases either after cyst excision alone (4/17) or patch angioplasty (2/2). There was no recurrence after vessel excision with interposition grafting (0/7). Therefore, vessel excision was a statistically significant factor in recurrence prevention (P=0.026). Among the six recurrences, joint connections of the cystic lesions were found in four of the six (66.7%).CONCLUSION: As a curative surgery for ACD, vessel excision with interposition grafting is a better strategy to prevent recurrence than simple cyst excision alone.
Adventitia ; Angioplasty ; Humans ; Intermittent Claudication ; Joints ; Recurrence ; Retrospective Studies ; Risk Factors ; Transplants

BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.
Aged ; Alzheimer Disease* ; Atrophy* ; Cognition Disorders ; Dementia* ; Diagnosis ; Humans ; Korea* ; Pemetrexed ; ROC Curve

BACKGROUND AND OBJECTIVES: Even patients with compensated peripheral vestibular dysfunction may report a sense of disequilibrium during daily activities, which often fail conventional vestibular function tests as attentional demand required for postural control may increase in these patients. The study aims to assess the feasibility of dual task test using concurrent cognitive tasks in a modified clinical test of sensory interaction on balance (mCTSIB) to measure increased attentional demand for posture control. SUBJECTS AND METHOD: Nineteen patients suspected with chronic dizziness were recruited by history reviews and physical examinations. Data for center of pressure (COP) variability and mean velocity during mCTSIB on a force long plate were analyzed, and time taken to react to the auditory stimuli were used to measure the attentional demand required for adequate postural control during platform perturbation. RESULTS: The mean COP range and velocity during mCTSIB were comparable between single and dual task conditions in patients with dizziness. Reaction time (RT) to auditory stimulus of 1 kHz pure tone in patients with chronic dizziness was also comparable to normal subjects. Interestingly, there was a tendency for increased RT in patients with documented caloric weakness, suggesting that attentional demand is increased in these patients. CONCLUSION: RT of dual task tests using auditory stimuli during mCTSIB may provide additional information about increased attentional demand for postural control in patients with vestibular dysfunction.
Dizziness* ; Humans ; Methods ; Physical Examination ; Posture ; Reaction Time ; Task Performance and Analysis ; Vestibular Diseases ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: Apurinic/apyrimidinic endonuclease 1/redox effector factor-1 (APE1/Ref-1) is a multifunctional protein involved in the DNA base excision repair pathway, inflammation, angiogenesis, and survival pathways. We investigated serum APE1/Ref-1 in patients with coronary artery disease (CAD). SUBJECTS AND METHODS: Serum APE1/Ref-1 was measured with a sandwich enzyme-linked immunosorbent assay from 360 patients who received coronary angiograms. They were divided into two groups; a control (n=57) and a CAD group (n=303), the latter included angina (n=128) and myocardial infarction (MI, n=175). RESULTS: The levels of APE1/Ref-1 were higher in the CAD than the control (0.63+/-0.07 vs. 0.12+/-0.07 ng/100 microL, respectively; p<0.01). They were also higher in MI than angina (0.81+/-0.10 vs. 0.38+/-0.11 ng/100 microL, respectively; p<0.01) and different according to the thrombolysis in myocardial infarction (TIMI) flow (0.88+/-0.09 for TIMI flow 0, 1, 2 vs. 0.45+/-0.13 ng/100 microL for TIMI flow 3, p<0.01) in acute coronary syndrome. In correlation analysis, the levels of APE1/Ref-1 were positively correlated with Troponin I (r=0.222; p<0.0001) and N-terminal pro-B type natriuretic peptide (NT-proBNP, r=0.217; p<0.0001) but not high sensitivity to C-reactive protein. Also, they revealed a negative correlation with ejection fraction (EF, r=-0.221; p=0.002). However, there were no significant differences among the three groups, were divided by their levels of APE1/Ref-1, for major adverse cardiovascular events (death, recurrent MI, stroke, revascularization) (8.2 vs. 14.0 vs. 12.5%, p=ns). CONCLUSION: The levels of serum APE1/Ref-1 are elevated in CAD, and are higher in MI than in angina. They are correlated with Troponin I, NT-proBNP, and EF.
Acute Coronary Syndrome ; Biomarkers ; C-Reactive Protein ; Coronary Artery Disease* ; Coronary Vessels* ; DNA ; DNA Repair ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Myocardial Infarction ; Stroke ; Troponin I

We intended to determine that virtual endoscopy and laparoscopy of the stomach based on serially sectioned cadaver images is beneficial. Therefore, the outlines between the gastric wall and lumen were traced using the new female data of the Visible Korean to build a volume model. While the outlines were expanded at appropriate thicknesses, the stomach was observed endoscopically and laparoscopically in comparison with a chosen sectioned image. Four layers (mucosa, submucosa, muscular layer, and serosa) of the stomach were discernible by their proper colors in the sectioned images. All layers except the submucosa were identified in the endoscopic and laparoscopic views by using consistent colors. The stepwise expansion of the outlines revealed thickness of each layer as well as whether the thickness was uniform. Our ideas and the Visible Korean images could be a robust resource of virtual reality learning for medical students and clinicians.
Adult ; Cadaver ; Female ; *Gastroscopy ; Humans ; Imaging, Three-Dimensional ; *Laparoscopy ; Models, Anatomic ; Stomach/*pathology

PURPOSE: In the present study, we aimed to determine the risk factors for the development of cystic periventricular leukomalacia (CPVL) in very low birth weight (VLBW) infants. METHODS: We reviewed the medical records of 309 infants weighing less than 1,500 g who were admitted to the neonatal intensive care unit at Hanyang University Medical Center, Seoul from April 2007 to December 2012. Thirty-nine infants died within 28 days of birth. Of the remaining 270 infants, 21 with CPVL established by cranial ultrasonography, and 63 without CPVL, who were matched for gestational age, were enrolled in this study. Univariate and multivariate analyses of maternal, perinatal, and neonatal risk factors for CPVL were performed through retrospective assessment of data collected from the medical records. RESULTS: Necrotizing enterocolitis (NEC > or =stage II: 42.9% vs. 9.5%, P=0.002), culture-proven sepsis (66.7% vs. 34.9%, P=0.021), hypotension with sepsis (33.3% vs. 6.3%, P=0.004), and severe intraventricular hemorrhage (> or =grade III: 61.9% vs. 22.2%, P=0.002) were associated with the development of CPVL on univariate analysis. Using multivariate logistic regression analysis, two variables were found to be statistically significant independent risk factors: NEC (> or =stage II: adjusted OR, 5.12; 95% CI, 1.219-21.514; P=0.026) and hypotension with sepsis (adjusted OR, 8.23; 95% CI, 1.194-56.713; P=0.032). CONCLUSION: NEC (> or =stage II) and hypotension with sepsis were associated with an increased risk of developing CPVL in VLBW infants.
Academic Medical Centers ; Enterocolitis, Necrotizing ; Gestational Age ; Hemorrhage ; Humans ; Hypotension ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Leukomalacia, Periventricular* ; Logistic Models ; Medical Records ; Multivariate Analysis ; Parturition ; Retrospective Studies ; Risk Factors* ; Seoul ; Sepsis ; Ultrasonography