PURPOSE: We sought to evaluate the distribution and characteristics of meibomian gland dysfunction (MGD) and the treatment patterns for symptomatic MGD patients in South Korea. METHODS: One hundred ninety-six right eyes of 196 MGD patients were enrolled. For each patient, meibum expressibility in the central eight glands in both the upper and lower eyelids was examined. Each upper and lower eyelid was separately classified into one of the following three subtypes: nonobvious obstructive (low-delivery without lid margin abnormality), obvious obstructive (low-delivery with lid margin abnormality), and hypersecretory (high-delivery with lid margin abnormality). All treatment plans were also recorded. RESULTS: The mean number of expressible glands of the central eight glands in the upper eyelids (3.9 ± 2.6) was significantly higher than that in the lower eyelids (2.2 ± 2.4, p < 0.001). Obvious obstructive MGD was the most common subtype, followed by the hypersecretory and nonobvious obstructive subtypes in both the upper and lower eyelids. Of the 196 subjects, 38 (19.4%) had upper and lower eyelids that were assigned to different categories. Eyelid hygiene was the most prescribed treatment (74.5%), followed by lubricant eye drop usage (71.5%). Physicians tended to determine treatment plans based on the subtype of the upper eyelid rather than that of the lower eyelid. CONCLUSIONS: The majority of subjects were classified as having the obvious obstructive subtype of MGD, and 19.4% had upper and lower eyelids that were different subtypes. Eyelid hygiene was the most prescribed treatment for MGD patients, and treatment patterns were mostly determined based on the subtype of the upper eyelids.
Classification ; Diagnosis ; Eyelids ; Humans ; Hygiene ; Korea ; Meibomian Glands

BACKGROUND: Topical hemostatic agents are used when ligation, electrocauterization, or other conventional hemostatic methods are impractical. Because a hemostatic agent is a foreign body, it can cause foreign body reactions, inflammation, and infections that can interfere with the wound healing process. Therefore, we should select hemostatic agents after considering their effects on wound healing. Here, we compared the effects of hemostatic agents on wound healing in a rectus abdominis muscle defect in rats. METHODS: Twelve Sprague Dawley rats were subjected to creation of a 6 × 6 mm defect in the rectus abdominis muscle and divided into four groups: control group; group A, Tachosil fibrin sealant patch; group B, Surgicel Fibrillar oxidized regenerated cellulose; and group C, Surgicel Snow oxidized regenerated cellulose. For the histologic analysis, biopsies were performed on the 3rd, 7th, and 27th days. RESULTS: The foreign body reaction was the weakest in group A and most significant in group C. The inflammatory cell infiltration was the weakest in group A and similar in groups B and C. Muscle regeneration differed among periods. The rats in group A were the most active initially, while those in group C showed prolonged activity. CONCLUSION: Tachosil and Surgicel administration increased inflammation via foreign body reactions, but the overall wound healing process was not significantly affected. The increased inflammation in the Surgicel groups was due to a low pH. We recommend using Tachosil, because it results in less intense foreign body reactions than Surgicel and faster wound healing due to the fibrin action.
Animals ; Biopsy ; Cellulose ; Cellulose, Oxidized ; Fibrin Tissue Adhesive ; Fibrin ; Fibrinogen ; Foreign Bodies ; Foreign-Body Reaction ; Hemostatics ; Hydrogen-Ion Concentration ; Inflammation ; Ligation ; Rats ; Rats, Sprague-Dawley ; Rectus Abdominis ; Regeneration ; Snow ; Thrombin ; Wound Healing ; Wounds and Injuries

PURPOSE: The purpose of this study was to evaluate the diagnostic efficacy of fine-needle aspiration (FNA), core needle biopsy (CNB), and combined FNA/CNB for the first-line diagnosis of thyroid nodules. METHODS: A total of 782 consecutive nodules that underwent simultaneous FNA and CNB were analyzed in this study. We compared the rate of inconclusive results and the diagnostic values for malignancy among FNA, CNB, and combined FNA/CNB. RESULTS: CNB showed a lower rate (10.2%) of inconclusive results than FNA (23.7%) (P < 0.001). Combined FNA/CNB showed a lower rate (6.5%) of inconclusive results than FNA (all nodules, P < 0.001; macronodules, P < 0.001; and micronodules, P < 0.001, respectively) or CNB (all nodules, P < 0.001; macronodules, P < 0.001; and micronodules, P=0.003, respectively). Combined FNA/CNB and CNB showed significantly higher sensitivity, accuracy, and diagnostic performance for malignancy as defined by criterion 1 (Bethesda category VI) or criterion 2 (Bethesda categories IV/V/VI) than FNA (P < 0.001). However, there was no significant difference in the sensitivity, accuracy, or diagnostic performance between combined FNA/CNB and CNB (with criterion 1, P=0.063, P=0.063, and P=0.412, respectively; with criterion 2, P=0.500, P=0.500, and P=0.348, respectively). CONCLUSION: CNB was found to be more effective than FNA for the diagnosis of thyroid nodules, and its sensitivity and diagnostic performance for malignancy were similar to those of combined FNA/CNB. CNB has the potential to be an effective alternative first-line diagnostic tool for thyroid nodules when performed by an experienced operator.
Biopsy, Fine-Needle ; Biopsy, Large-Core Needle* ; Cohort Studies* ; Diagnosis ; Retrospective Studies* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

BACKGROUND: The Korea Radiation Effect & Epidemiology Cohort METHODS: Using the KREEC-R raw data, we calculated age standardized rates (ASRs) of female thyroid cancer and re-analyzed the results of survey on the use of medical services. We also marked the administrative districts of residents who received the Radiation Health Research Institute (RHRI) health examinations and those in which thyroid cancer case occurred as per the Chonnam National University Research Institute of Medical Sciences (RIMS) final report on maps where the locations of NPPs and 5 km-radii around them were also indicated. And we compared the incidence rates of Radiation-induced cancer measured between the first period when RHRI health examinations were not yet implemented, and the second period when the RHRI health examinations were implemented. RESULTS: The ASR for the far-distance group, which comprised residents living in areas outside the 30 km radius of the NPPs, increased rapidly after 2000; however, that of the exposed group, which comprised residents living within a 5 km radius of the NPPs, started to increase rapidly even before 1995. The frequencies of the use of medical services were significantly higher in the intermediate proximate group, which comprised residents living within a 5–30 km radius of the NPPs, than in the exposed group in women. In case of female thyroid cancer, the second period ASR was higher than the first period ASR, but in case of female liver cancer and female stomach cancer no significant difference were observed between the periods. On map, many administrative districts of residents who received RHRI health examinations and most administrative districts in which thyroid cancer case occurred on RIMS final report were outside 5 km-radii around NPPs. CONCLUSIONS: We could not find any evidence supporting the assertion that detection bias influenced the increased risks of female thyroid cancer observed in the exposed group of the KREEC-R study, as opposed to the control group.
Academies and Institutes ; Bias (Epidemiology) ; Cohort Studies ; Epidemiology ; Female ; Humans ; Incidence ; Jeollanam-do ; Korea ; Liver Neoplasms ; Neoplasms, Radiation-Induced ; Nuclear Power Plants ; Radiation Effects ; Radius ; Stomach Neoplasms ; Thyroid Gland ; Thyroid Neoplasms

HemoHIM, herbal preparation has designed for immune system recovery. We investigated the anti-inflammatory effect of HemoHIM on cigarette smoke (CS) and lipopolysaccharide (LPS) induced chronic obstructive pulmonary disease (COPD) mouse model. To induce COPD, C57BL/6 mice were exposed to CS for 1 h per day (eight cigarettes per day) for 4 weeks and intranasally received LPS on day 26. HemoHIM was administrated to mice at a dose of 50 or 100 mg/kg 1h before CS exposure. HemoHIM reduced the inflammatory cell count and levels of tumor necrosis factor receptor (TNF)-α, interleukin (IL)-6 and IL-1β in the broncho-alveolar lavage fluid (BALF) induced by CS+LPS exposure. HemoHIM decreased the inflammatory cell infiltration in the airway and inhibited the expression of iNOS and MMP-9 and phosphorylation of Erk in lung tissue exposed to CS+LPS. In summary, our results indicate that HemoHIM inhibited a reduction in the lung inflammatory response on CS and LPS induced lung inflammation via the Erk pathway. Therefore, we suggest that HemoHIM has the potential to treat pulmonary inflammatory disease such as COPD.
Animals ; Cell Count ; Immune System ; Inflammation* ; Interleukins ; Lung ; MAP Kinase Signaling System ; Matrix Metalloproteinase 9 ; Mice ; Phosphorylation ; Plant Preparations* ; Pneumonia ; Pulmonary Disease, Chronic Obstructive ; Receptors, Tumor Necrosis Factor ; Smoke* ; Therapeutic Irrigation ; Tobacco Products*

Glioblastoma multiforme (GBM) is the most common and aggressive form of brain tumors. GBMs, like other tumors, rely relatively less on mitochondrial oxidative phosphorylation (OXPHOS) and utilize more aerobic glycolysis, and this metabolic shift becomes augmented under hypoxia. In the present study, we investigated the physiological significance of altered glucose metabolism and hypoxic adaptation in the GBM cell line U251 and two newly established primary GBMs (GBM28 and GBM37). We found that these three GBMs exhibited differential growth rates under hypoxia compared to those under normoxia. Under normoxia, the basal expressions of HIF1α and the glycolysis-associated genes, PDK1, PDK3, and GLUT1, were relatively low in U251 and GBM28, while their basal expressions were high in GBM37. Under hypoxia, the expressions of these genes were enhanced further in all three GBMs. Treatment with dichloroacetate (DCA), an inhibitor of pyruvate dehydrogenase kinase (PDK), induced cell death in GBM28 and GBM37 maintained under normoxia, whereas DCA effects disappeared under hypoxia, suggesting that hypoxic adaptation dominated DCA effects in these GBMs. In contrast, the inhibition of HIF1α with chrysin suppressed the expression of PDK1, PDK3, and GLUT1 and markedly promoted cell death of all GBMs under both normoxia and hypoxia. Interestingly, however, GBMs treated with chrysin under hypoxia still sustained higher viability than those under normoxia, and chrysin and DCA co-treatment was unable to eliminate this hypoxia-dependent resistance. Together, these results suggest that hypoxic adaptation is critical for maintaining viability of GBMs, and targeting hypoxic adaptation can be an important treatment option for GBMs.
Anoxia ; Brain Neoplasms ; Cell Death* ; Cell Line ; Dichloroacetic Acid ; Glioblastoma* ; Glucose ; Glycolysis ; Metabolism ; Oxidative Phosphorylation ; Oxidoreductases ; Phosphotransferases ; Pyruvic Acid

Hepcidin expression is induced by inflammatory molecules such as lipopolysaccharide (LPS) via a macrophage-mediated pathway. Although hepatocytes directly respond to LPS, the molecular mechanism underlying toll-like receptor (TLR)-dependent hepcidin expression by hepatocytes is mostly unknown. Here we show that LPS can directly induce the mRNA expression and secretion of hepcidin by hepatocytes via TLR4 activation. Using hepatocytes deficient in TLR4, myeloid differentiation factor 88 (MyD88) and TIR domain-containing adaptor inducing interferon-β (TRIF), we demonstrated that LPS-induced hepcidin expression by hepatocytes is regulated by its specific receptor, TLR4, via a MyD88-dependent signaling pathway. Hepcidin promoter activity was significantly increased by MyD88-dependent downstream signaling molecules (interleukin-1 receptor-associated kinase (IRAK) and tumor necrosis factor receptor-associated factor 6 (TRAF6), which activate c-Jun N-terminal kinase (JNK) and activator protein-1 (AP-1). We then confirmed that LPS stimulation induced the phosphorylation of JNK and c-Jun, and observed strong occupancy of the hepcidin promoter by c-Jun. Promoter mutation analysis also identified the AP-1-binding site on the hepcidin promoter. Finally, bone marrow transplantation between wild-type and TLR4 knockout mice revealed that hepatic TLR4-dependent hepcidin expression was comparable to macrophage TLR4-dependent hepcidin expression induced by LPS. Taken together, these results suggest that TLR4 expressed by hepatocytes regulates hepcidin expression via the IRAK–TRAF6–JNK–AP-1 axis.

PURPOSE: To analyze the feasibility of three-dimensional (3D) diffusion-weighted (DW) PSIF (reversed FISP [fast imaging with steady-state free precession]) sequence in order to evaluate peripheral nerves in the elbow. MATERIALS AND METHODS: Ten normal, asymptomatic volunteers were enrolled (6 men, 4 women, mean age 27.9 years). The following sequences of magnetic resonance images (MRI) of the elbow were obtained using a 3.0-T machine: 3D DW PSIF, 3D T2 SPACE (sampling perfection with application optimized contrasts using different flip angle evolution) with SPAIR (spectral adiabatic inversion recovery) and 2D T2 TSE (turbo spin echo) with modified Dixon (m-Dixon) sequence. Two observers used a 5-point grading system to analyze the image quality of the ulnar, median, and radial nerves. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of each nerve were measured. We compared 3D DW PSIF images with other sequences using the Wilcoxon-signed rank test and Friedman test. Inter-observer agreement was measured using intraclass correlation coefficient (ICC) analysis. RESULTS: The mean 5-point scores of radial, median, and ulnar nerves in 3D DW PSIF (3.9/4.2/4.5, respectively) were higher than those in 3D T2 SPACE SPAIR (1.9/2.8/2.8) and 2D T2 TSE m-Dixon (1.7/2.8/2.9) sequences (P < 0.05). The mean SNR in 3D DW PSIF was lower than 3D T2 SPACE SPAIR, but there was no difference between 3D DW PSIF and 2D T2 TSE m-Dixon in all of the three nerves. The mean CNR in 3D DW PSIF was lower than 3D T2 SPACE SPAIR and 2D T2 TSE m-Dixon in the median and ulnar nerves, but no difference among the three sequences in the radial nerve. CONCLUSION: The three-dimensional DW PSIF sequence may be feasible to evaluate the peripheral nerves around the elbow in MR imaging. However, further optimization of the image quality (SNR, CNR) is required.
Elbow Joint ; Elbow* ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Peripheral Nerves* ; Pilot Projects* ; Radial Nerve ; Signal-To-Noise Ratio ; Ulnar Nerve ; Volunteers

Orientia tsutsugamushi (O. tsutsugamushi), which is endemic to an Asia-Pacific region, has increased its incidence and caused annually around 10 thousand patients infected with scrub typhus in Korea in the past several years. In the present study, we isolated 44 O. tsutsugamushi from the patients with febrile illness accompanied with or without an eschar in Gyeongsangnam-do, Korea. These isolates were characterized by genetic analysis of the major outer membrane protein, the 56-kDa type-specific antigen (tsa56), which is unique to O. tsutsugamushi. Two types of sequences of tsa56, designated by JJ1 and JJ2, were determined from 37 and 7 isolates of the 44 isolates, respectively. JJ1 and JJ2 showed 74.7~90.8% identity in nucleotide sequence and 66.1~90.5% identity in amino acid sequence with 33 reference strains except for Boryong and Kuroki. JJ1 and JJ2 had 100 and 99.9% nucleotide identity to Boryong strain, and 99.9 and 99.8% to Kuroki, which has been known to be similar to Boryong, respectively. In addition, they showed 77.9~ 81.4% nucleotide identity with the cluster of Gilliam-related genotypes, whereas they showed higher nucleotide identity (89.6~90.8%) with the cluster of Karp-related genotypes. To our knowledge, this is the first report to isolate O. tsutsugamushi and characterize their genotype as the Boryong in Jinju and West Gyeongsangnam-do, Korea, even though it has been reported that the Boryong was the predominant genotype in isolates from chiggers, domestic rodents, and patients in the southern part of Korea. Furthermore, our isolates could be useful source to study on the pathophysiology and epidemiology of scrub typhus in Korea.
Amino Acid Sequence ; Base Sequence ; Chungcheongnam-do ; Epidemiology ; Genotype ; Gyeongsangnam-do* ; Humans ; Incidence ; Korea* ; Membrane Proteins ; Orientia tsutsugamushi* ; Rodentia ; Scrub Typhus* ; Trombiculidae

BACKGROUND/AIMS: Hepatic angiosarcoma, a rare and aggressive liver malignancy, is difficult to diagnose because of a lack of specific clinical features. The clinical and radiological features of patients with histologically confirmed hepatic angiosarcoma were examined. METHODS: Among 2,336 patients diagnosed with primary hepatic carcinoma at Keimyung University Dongsan Medical Center (Daegu, Korea) between May 2002 and February 2012, eight (0.03%) with histologically confirmed primary hepatic angiosarcoma were included. The patterns of disease diagnosis, tumor characteristics, treatment responses, and prognoses were reviewed retrospectively. RESULTS: Median age was 66 years-old (range, 41-80 years). Four patients were male. Five patients were compulsive drinkers. All patients had no HBsAg and anti-HCV. Initial radiologic diagnoses revealed primary hepatic angiosarcoma (n=2), hepatocellular carcinoma (n=2), hemangioma (n=2), and hepatic metastatic carcinoma (n=2). Definitive diagnoses were made by percutaneous needle biopsies in seven patients and surgical resection in one patient. At the time of the initial diagnosis, extrahepatic metastases were detected in three patients (37.5%). Metastatic sites included the spleen and lung, pericardium, and bone, in one patient each. Two patients underwent conservative treatments. The remaining patients underwent surgical resection (n=1), transcatheter arterial chemoembolization (n=1), and systemic chemotherapy (n=4). The median survival period was 214 days (range, 21-431 days). CONCLUSIONS: Hepatic angiosarcoma is a highly progressive disease with a poor prognosis. Detailed studies including histological examinations are essential to facilitate early diagnosis of the disease.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/therapeutic use ; Embolization, Therapeutic ; Female ; Hemangiosarcoma/*diagnosis/pathology/therapy ; Humans ; Immunohistochemistry ; Liver Neoplasms/*diagnosis/pathology/therapy ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed