Background: Melanoma is one of the most aggressive and metastatic skin cancers. Although overexpression of Dock180 and Elmo1 has been identified in various cancers, including glioma, ovarian cancer, and breast cancer, their expression and functions in melanoma remain unknown. Objective: This study aims to confirm the expression of Dock180 and Elmo1, their underlying mechanisms, and roles in melanoma. Methods: Both immunohistochemical staining and Western blotting were used to confirm expression of Dock180 and Elmo1 in human melanoma. To identify roles of Dock180 and Elmo1 in cell survival, apoptosis and migration, downregulation of Dock180 or Elmo1 in melanoma cells with small interfering RNA (siRNA) was performed. Results: We identified overexpression of Dock180 and Elmo1 in human melanoma compared to normal skin ex vivo. Inhibition of Dock180 or Elmo1 following siRNA in melanoma cells reduced cell viability and increased apoptosis as supported by increased proportion of cells with Annexin V-PE (+) staining and sub-G0/G1 peak in cell cycle analysis. Moreover, inhibition of Dock180 or Elmo1 regulated apoptosis-related proteins, showing downregulation of Bcl-2, caspase-3, and PARP and upregulation of Bax, PUMA, cleaved caspase-3, and cleaved PARP. Furthermore, knockdown of Dock180 and Elmo1 in melanoma cells reduced cell migration and changed cellular signaling pathways including ERK and AKT. Vemurafenib decreased cell viability in concentration-dependent manner, while transfection with Dock180- or Elmo1-specific siRNA in melanoma cells significantly reduced cell viability. Conclusion Our results suggest that both Dock180 and Elmo1 may be associated with cancer progression, and can be potential targets for treatment of melanoma.

Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.
Accessory Nerve Injuries* ; Accessory Nerve* ; Adult ; Ambulatory Care Facilities ; Electromyography ; Female ; Follow-Up Studies ; Humans ; Musculoskeletal Manipulations* ; Needles ; Neural Conduction ; Range of Motion, Articular ; Shoulder ; Shoulder Pain

Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician’s clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.
Arthritis ; Arthritis, Rheumatoid* ; Classification ; Consensus ; Fatigue ; Humans ; Judgment* ; Logistic Models ; Observational Study ; Rheumatic Diseases

OBJECTIVE: The purpose of the present study was 1) to identify factors that may influence academic stress in medical students and 2) to investigate the causal relationships among these variables with path analysis. METHODS: One hundred sixty medical students participated in the present study. Psychological parameters were assessed with the Medical Stress Scale, Minnesota Multiphasic Personality Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Academic Motivation Scale. Linear regression and path analysis were used to examine the relationships among variables. RESULTS: Significant correlations were noted between several factors and Medical Stress scores. Specifically, Hamilton Depression Scale scores (beta=0.26, p=0.03) and amotivation (beta=0.20, p=0.01) and extrinsically identified regulation (beta=0.27, p<0.01) response categories on the Academic Motivation Scale had independent and significant influences on Medical Stress Scale scores. A path analysis model indicated that stress, motivation, and academic performance formed a triangular feedback loop. Moreover, depression was associated with both stress and motivation, and personality was associated with motivation. CONCLUSION: The triangular feedback-loop structure in the present study indicated that actions that promote motivation benefit from interventions against stress and depression. Moreover, stress management increases motivation in students. Therefore, strategies designed to reduce academic pressures in medical students should consider these factors. Additional studies should focus on the relationship between motivation and depression.
Depression ; Humans ; Linear Models ; MMPI ; Models, Structural ; Motivation ; Schools, Medical ; Students, Medical

Paragangliomas of the urinary bladder are very rare tumors of the paraganglion system that arise from chromaffin cells in or near the sympathetic ganglia. Only approximately 15% of them develop from extra-adrenal chromaffin tissue. Most of these tumors are hormonally active and secrete mainly noradrenaline (rarely adrenaline), calcitonin, and adrenocorticotropic hormone. Paragangliomas are generally benign tumors, with less than 10% being malignant. Here we report a case of a paraganglioma arising in a urinary bladder with a bladder stone.
Adrenocorticotropic Hormone ; Calcitonin ; Chromaffin Cells ; Ganglia, Sympathetic ; Norepinephrine ; Paraganglioma ; Urinary Bladder ; Urinary Bladder Calculi

PURPOSE: In bladder cancer screening, many methods such as urinary cytology, bladder tumor antigen, and nuclear matrix protein-22 are well known. To learn the value of urinary melanoma antigen gene expression (MAGE) in bladder cancer screening, we compared the urinary MAGE test with irrigated urinary cytology. MATERIALS AND METHODS: From July 2000 to July 2007, a total of 142 patients were enrolled in this study. We divided these patients into 2 groups. Eighty-eight patients with bladder cancer were included in group I. Group II consisted of 54 patients who had been treated for bladder cancer and had no evidence of tumor by cystoscopy and irrigated urinary cytology. Urinary cytology, urinary MAGE test, and cystoscopy were performed in all patients. The urinary MAGE test was done by reverse transcriptase polymerase chain reaction (RT-PCR). Sensitivity and specificity were investigated according to cancer grade and stage. RESULTS: The overall sensitivity of the urinary MAGE test and urinary cytology was 69.3% (61/88) and 53.4% (47/88), respectively (p=0.03). The specificity of the urinary MAGE test and urinary cytology was 75.9% (41/54) and 83.3% (45/54), respectively (p=0.34). The sensitivity of each test in superficial tumors (Ta, T1) was 65.5% (38/58) and 46.6% (27/58), respectively (p=0.04). In advanced disease (> or =T2), the sensitivity of the tests was 76.7% (23/30) and 66.7% (20/30), respectively (p=0.39). The sensitivity of the urinary MAGE test in grade 1 tumors (60.5%, 23/38) was significantly higher (p=0.01) than that of urinary cytology (31.6%, 12/38). CONCLUSIONS: The urinary MAGE test was more sensitive than urinary cytology in bladder cancer screening. We consider the urinary MAGE test to possibly be a valuable test together with urinary cytology, especially for Grade 1 and Ta, T1 bladder cancer.
Cystoscopy ; Gene Expression ; Humans ; Mass Screening ; Melanoma ; Nuclear Matrix ; Reverse Transcriptase Polymerase Chain Reaction ; Sensitivity and Specificity ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: Nocturia has been one of the most bothersome symptoms in benign prostatic hyperplasia (BPH) patients. Therefore, the authors evaluated the effect of tolterodine and oxybutyninin on nocturia in BPH patients. MATERIALS AND METHODS: From September 2006 to March 2007, 82 patients who presented over than 2 in nocturnal bladder capacity index (NCBI) in spite of having alpha blockers for 6 months were enrolled. Group I (n=38) took alpha blocker with tolterodine, group II (n=44) took alpha blocker with oxybutynin. The number of their nocturia episodes was separately evaluated by the time before and after the medication. The complications were assessed using a questionnaire. RESULTS: The number of nocturia episodes decreased by at least 1 in 68.4% (26/38), 84.1% (37/44) of patients in group I, II, respectively, and decreased by 2 or more, 1 and were unchanged or increased were 36.8, 31.6, 31.6% in group I patients and 45.5, 38.6, 15.9% in group II patients, respectively. In baseline nocturia > or =6 group, the nocturia decreased by 1 or more in 66.7%, 77.8% in group I, II, respectively. Adverse events, including dry mouth, dizziness, headache, etc, occurred in 21.1% (8/38) in group I and 27.3% (12/44) in group II patients. The complications between two groups showed no significant differences. CONCLUSIONS: Alpha blockers with tolterodine or oxybutynin can be effectively combined as a treatment option for patients with BPH complaining of unresolved nocturia.
Dizziness ; Headache ; Humans ; Mouth ; Nocturia* ; Prostatic Hyperplasia* ; Surveys and Questionnaires ; Urinary Bladder ; Tolterodine Tartrate

BACKGROUND: To evaluate the usefulness of the modified lateral pillar classification as a prognostic factor in Legg-Calve-Perthes disease (LCPD). METHODS: Thirty nine patients diagnosed with lateral pillar C in LCPD from May, 1977, to October, 2001 were reviewed, and their skeletal maturity was followed. The mean follow up duration was 12 years and 7 months (4 years, 6 months to 24 years, 9 months). Lateral pillar C classification was divided into C1 (50-75% collapse of the lateral pillar) and C2 (> 75%). All radiological and clinical prognostic factors were evaluated. The final results were evaluated according to the Stulberg classification. RESULTS: Twenty one and 18 of the affected hips were in groups C1 and C2, respectively. According to the Stulberg classification, the final results of group C1 were better than those of C2 (p = 0.002). Patients with more head-at-risk signs had significantly poorer outcomes. CONCLUSIONS: The modified lateral pillar classification has significant value for predicting the prognosis of LCPD.
Adolescent ; Adult ; Chi-Square Distribution ; Child ; Child, Preschool ; Female ; Femur Head/*pathology/radiography ; Follow-Up Studies ; Hip Joint/*pathology/radiography ; Humans ; Legg-Perthes Disease/*classification/*pathology/radiography/therapy ; Male ; Predictive Value of Tests ; Prognosis ; Treatment Outcome ; Young Adult

Adenomatoid tumors arising in the parenchyma of the testes are extremely rare neoplasms, and they uniformly behave in a benign fashion. The long reorted history of these tumors and the absence of distant metastasis suggest a benign nature. Thus, the treatment is surgical excision. We report here on a case of an adenomatoid tumor of the testis. Radical orchiectomy was performed, and this revealed an adenomatoid tumor of the parenchyma of the testis.
Neoplasm Metastasis

Adenomatoid tumors arising in the parenchyma of the testes are extremely rare neoplasms, and they uniformly behave in a benign fashion. The long reorted history of these tumors and the absence of distant metastasis suggest a benign nature. Thus, the treatment is surgical excision. We report here on a case of an adenomatoid tumor of the testis. Radical orchiectomy was performed, and this revealed an adenomatoid tumor of the parenchyma of the testis.
Neoplasm Metastasis