BACKGROUND: The purpose of this study was to compare clinical and radiological results of arthrodesis performed by the anterior approach and by the transfibular approach in ankle osteoarthritis. METHODS: Sixty patients underwent open arthrodesis (38 by the anterior approach and 22 by the transfibular approach). The visual analogue scale score and the American Orthopedic Foot and Ankle Society (AOFAS) score were examined clinically, and radiological examination was performed on the alignment of the lower extremity and bone union. RESULTS: Both groups showed significant improvement in AOFAS score (from 39.8 to 58.3 in the anterior approach group and from 44.5 to 60.7 in the transfibular approach group). There was no significant difference in AOFAS score at the last follow-up in both groups. The time to fusion was 13.5 weeks in the anterior approach group and 11.8 weeks in the transfibular approach group. Nonunion occurred in four cases in the anterior approach group and in one case in the transfibular approach group. CONCLUSIONS: Ankle arthrodesis by the anterior approach and the transfibular approach showed comparably good clinical results.
Ankle* ; Arthrodesis* ; Follow-Up Studies ; Foot ; Humans ; Lower Extremity ; Orthopedics ; Osteoarthritis

The small GTP-binding protein Rab25 is associated with tumor formation and progression. However, recent studies have shown discordant effects of Rab25 on cancer cell progression depending on cell lineage. In the present study, we elucidate the underlying mechanisms by which Rab25 induces cellular invasion. We demonstrate that Rab25 increases β1 integrin levels and subsequent activation of EGFR and upregulation of VEGF-A expression, leading to increased Snail expression, epithelial-to-mesenchymal transition and cancer cell invasiveness. Strikingly, we identify that Snail mediates Rab25-induced cancer cell invasiveness through fascin expression and that ectopic expression of Rab25 aggravates metastasis of ovarian cancer cells to the lung. We thus demonstrate a novel role of a β1 integrin/EGFR/VEGF-A/Snail signaling cascade in Rab25-induced cancer cell aggressiveness through induction of fascin expression, thus providing novel biomarkers and potential therapeutic targets for Rab25-expressing cancer cells.
Biomarkers ; Cell Lineage ; Ectopic Gene Expression ; GTP-Binding Proteins ; Lung ; Neoplasm Metastasis ; Ovarian Neoplasms ; Snails ; Up-Regulation ; Vascular Endothelial Growth Factor A

Hippo/YAP signaling is implicated in tumorigenesis and progression of various cancers. By inhibiting a plethora signaling cascades, resveratrol has strong anti-tumorigenic and anti-metastatic activity. In the present study, we demonstrate that resveratrol decreases the expression of YAP target genes. In addition, our data showed that resveratrol attenuates breast cancer cell invasion through the activation of Lats1 and consequent inactivation of YAP. Strikingly, we also demonstrate that resveratrol inactivates RhoA, leading to the activation of Lats1 and induction of YAP phosphorylation. Further, resveratrol in combination with other agents that inactivate RhoA or YAP showed more marked suppression of breast cancer cell invasion compared with single treatment. Collectively, these findings indicate the beneficial effects of resveratrol on breast cancer patients by suppressing the RhoA/Lats1/YAP signaling axis and subsequently inhibiting breast cancer cell invasion.
Breast Neoplasms* ; Breast* ; Carcinogenesis ; Humans ; Phosphorylation

BACKGROUND: Inverted nipples can pose aesthetic and functional problems, especially for young women. The objectives of inverted nipple correction are both sufficient aesthetic projection of the nipple and postoperative functional preservation of the lactiferous ducts. Recurrence of nipple inversion is still an unsolved problem in many cases. We present a new nipple suspension technique using nipple- and areola-based dermal flaps for correcting inverted nipples and preserving the lactiferous duct to minimize the risk of recurrence. METHODS: We corrected six inverted nipples in three patients, which were classified as grade II using the Han and Hong classification of nipple inversion. The anteroposterior and lateral medical-quality photographs of the respective patients were identified for nipple protrusion and recurrence during a 6-month follow-up period to evaluate aesthetical goal and assess the sensitivity of the nipple to confirm preservation of the main lactiferous ducts. Surgical details are described within the main text. RESULTS: Preoperative and postoperative photography revealed good nipple protrusion during the 6-month follow-up period without any complications such as skin necrosis and recurrence. We were unable to directly identify breast-feeding function because all three patients were young and unmarried women. However, we assumed preservation of the main lactiferous duct since no nipple sensory change was identified in the postoperative examination when compared with the preoperative examination. CONCLUSIONS: With this method, we were able to confirm the hardness of the column and minimize the injury of the main lactiferous duct.
Breast ; Classification ; Female ; Follow-Up Studies ; Hardness ; Humans ; Inlays* ; Methods* ; Necrosis ; Nipples* ; Photography ; Recurrence ; Single Person ; Skin ; Surgical Flaps

PURPOSE: Tarsal coalition results from defects during the developmental stage and produes ankle pain and limitations in the range of motions. Its incidence has been reported to be 1%, but there has not been any reports with respect to Koreans. Therefore, we evaluated the prevalence of tarsal coalition in Koreans. MATERIALS AND METHODS: Between 2005 and 2014, we analyzed a total of 733 cases of foot and ankle magnetic resonance imaging (MRI) in our hospital. There were 391 men and 342 women. All MRI readings were read by a radiologist in our hospital. We classified the coalitions in accordance with the histological and anatomical characteristics, and calculated the prevalence in each group. Moreover, we tried to determine the prevalence of tarsal coalitions in accordance with sex, age, and proportion of the symptomatic tarsal coalitions. RESULTS: There were a total of 11 MRIs of tarsal coalition—9 talocalcaneal coalitions, 1 calcaneocuboidal coalition, and 1 calcaneonavicular coalition. Nine tarsal coalitions were observed in men and 2 in women. CONCLUSION: Through this study, we found that the prevalence of tarsal coalition, including the asymptomatic patients, is similar to the previously known prevalence (1%). By getting more MRIs of the foot and ankle, we could better represent the prevalence of tarsal coalitions in Koreans.
Ankle ; Female ; Foot ; Humans ; Incidence* ; Magnetic Resonance Imaging* ; Male ; Prevalence ; Reading

A 30-year-old male presented with multiple tender erythematous nodules, varying in size from 0.5 cm to 2 cm on the right shoulder of the body. He gave a history of pain associated with these lesions, especially on exposure to cold and touch. These lesions showed multi-segmental distribution; each began as a papule, which gradually increased both in size and number to form a nodule. The lesions, which were misdiagnosed as keloids at another hospital, were managed with numerous intralesional steroid injections. This treatment did not improve the symptoms. Based on the history and cutaneous findings during the physical examination, we considered a diagnosis of a benign tumor. Among the lesions, some of the larger ones were completely excised, followed by excision biopsy. We then made a diagnosis of cutaneous leiomyoma, more specifically, piloleiomyoma. The excisional lesions were covered by skin grafts and closed by primary repair.
Adult ; Biopsy ; Diagnosis ; Humans ; Keloid* ; Leiomyoma ; Male ; Physical Examination ; Shoulder* ; Skin ; Transplants

BACKGROUND: Ventilator-associated pneumonia (VAP) requires prompt and appropriate treatment. Since methicillin-resistant Staphylococcus aureus (MRSA) is a frequent pathogen in VAP, rapid identification of it, is pivotal. Our aim was to evaluate the utility of quantitative polymerase chain reaction (qPCR) as a useful method for etiologic diagnoses of MRSA pneumonia. METHODS: We performed qPCR for mecA, S. aureus-specific femA-SA, and S. epidermidis-specific femA-SE genes from bronchoalveolar lavage or bronchial washing samples obtained from clinically-suspected VAP. Molecular identification of MRSA was based on the presence of the mecA and femA-SA gene, with the absence of the femA-SE gene. To compensate for the experimental and clinical conditions, we spiked an internal control in the course of DNA extraction. We estimated number of colony-forming units per mL (CFU/mL) of MRSA samples through a standard curve of a serially-diluted reference MRSA strain. We compared the threshold cycle (Ct) value with the microbiologic results of MRSA. RESULTS: We obtained the mecA gene standard curve, which showed the detection limit of the mecA gene to be 100 fg, which corresponds to a copy number of 30. We chose cut-off Ct values of 27.94 (equivalent to 1x10(4) CFU/mL) and 21.78 (equivalent to 1x10(5) CFU/mL). The sensitivity and specificity of our assay were 88.9% and 88.9% respectively, when compared with quantitative cultures. CONCLUSION: Our results were valuable for diagnosing and identifying pathogens involved in VAP. We believe our modified qPCR is an appropriate tool for the rapid diagnosis of clinical pathogens regarding patients in the intensive care unit.
Adenosine ; Bronchoalveolar Lavage ; Coat Protein Complex I ; DNA ; Humans ; Critical Care ; Intensive Care Units ; Limit of Detection ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pneumonia, Ventilator-Associated ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Sprains and Strains ; Stem Cells

OBJECTIVE: To optimize the recanalization of acute cerebral stroke that were not effectively resolved by conventional intraarterial thrombolysis (IAT), we designed a double device technique to allow for rapid and effective reopening. In this article, we describe the feasibility and efficacy of this technique. METHODS: From January 2008 to September 2009, twenty patients with acute cerebral arterial occlusion (middle cerebral artery : n=12; internal carotid artery terminus : n=5; basilar artery : n=3) were treated by the double device technique. This technique was applied when conventional thrombolytic methods using drug, microwires, microcatheters and balloons did not result in recanalization. In the double device technique, two devices are simultaneously placed at the lesion (for example, one microcatheter and one balloon or two microcatheters). Chemicomechanical or mechanicomechanical thrombolysis was performed simultaneously using various combinations of two devices. Recanalization rates, procedural time, complications, and clinical outcomes were analyzed. RESULTS: The initial median National Institute of Health Stroke Scale (NIHSS) was 16 (range 5-26). The double device technique was applied after conventional IAT methods failed. Recanalization was achieved in 18 patients (90%). Among them, 55% (11 cases) were complete (thrombolysis in cerebral infarction 2B, 3). The median thrombolytic procedural time including the conventional technique was 135+/-83.7 minutes (range 75-427). Major symptomatic hemorrhages (neurological deterioration > or =4 points in NIHSS) developed in two patients (10%). Good long term outcomes (modified Rankin Scale < or =2 at 90 days) occurred in 25% (n=5) of the cases. Mortality within 90 days developed in two cases (10%). CONCLUSION: The double device technique is a feasible and effective technical option for large vessel occlusion refractory to conventional thrombolysis.
Basilar Artery ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction ; Glycosaminoglycans ; Hemorrhage ; Humans ; Stroke

Most cases of accessory spleen show similar features as normal spleen in imaging studies. However, some accessory spleen has unusual scan feature which can be misdiagnosed. We present a case of intrapancreatic accessory spleen that was discovered incidentally during a workup for abdominal pain in a 47-year-old woman. CT and MRI revealed a different enhancing pattern from that of the spleen. Further evaluation with endoscopic ultrasonography failed to identify the pancreatic mass. Therefore, it was surgically removed and diagnosed pathologically as an accessory spleen.
Diagnostic Errors ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/radionuclide imaging/surgery/ultrasonography ; Spleen/*pathology/radionuclide imaging/surgery ; Tomography, X-Ray Computed

Two male patients who presented with altered mental states and hemiparesis were treated by retrieval thrombectomy. The occlusion sites were M1 in both patients. During each thrombectomy, a self-expanding and fully retrievable Solitaire stent was partially deployed to cover the whole intra-arterial clot and then was retrieved slowly while occluding the internal cerebral artery with a balloon-guiding catheter. Complete recanalization (defined as thrombolysis of cerebral infarction grade 2b or 3) was achieved in both patients. The procedural time from groin puncture to recanalization was 17 min and 30 min, respectively. Immediate post-operative National Institutes of Health Stroke scores improved to 17 from 22 in one patient and to 19 from 24 in the other patient. There were no procedure-related complications including distal embolisms or post-operative intracranial hemorrhages. We suggest that this technique may be a simple, rapid, and safe thrombolytic method for acute ischemic stroke patients with large artery occlusions.
Arteries ; Catheters ; Cerebral Arteries ; Cerebral Infarction ; Embolism ; Groin ; Humans ; Intracranial Hemorrhages ; Male ; National Institutes of Health (U.S.) ; Paresis ; Punctures ; Stents ; Stroke ; Thrombectomy