This case report describes a successful use of normothermic targeted temperature management (TTM) for the treatment of a 14-year-old girl with exertional heat stroke. Upon hospitalization, she exhibited a 40.5 ℃ core temperature and multiorgan failure. We immediately applied the TTM, targeting a range of 36-37 ℃. Her condition improved rapidly, with vital signs stabilized and consciousness fully regained by day 3. She experienced a bimodal pattern of rhabdomyolysis during recovery, which was managed without further complications. No neurological sequelae were observed, and all laboratory parameters were normalized before discharge on day 10. This case suggests the potential efficacy of normothermic TTM in pediatric heat stroke.

OBJECTIVES: The aim of this study is to develop Treatment Guidelines for Alcohol Use Disorder-the Korean Addiction Treatment Guidelines-using the Adaptation method. METHODS AND PROCEDURES: As the Adaptation method of Guidelines, the ADAPTE Manual, which is developed by ADAPTE collaboration is applied. In Part 1 : preparatory work prior to the beginning of Adaptation is performed. In Part 2 : the core phase of the Adaptation in which we searched the guidelines and performed a systematic review of the literature. The two guidelines (of the AU and the UK) are selected by gone through the methodological quality and currency evaluation for guidelines. And, in order to choose the proper recommendations, the contents were evaluated with regard to the applicability and acceptability of guidelines to the domestic. Finally, in Part 3 : the adapted guideline is reviewed externally, with review and plan update. Therefore, in this way, the Korean Guidelines for Treatment of Alcohol Use Disorder, comprised of 55 recommendations, was developed. CONCLUSION: In this study, Korean Guidelines for Treatment of Alcohol Use Disorder were developed by application of the Adaptation method of ADAPTE. These are the first evidence-based Korean Guidelines for Treatment of Alcohol Use Disorder, which were modified and accepted in accordance with Korean circumstances within the range not damaging the validity of the treatment worth, and it is expected to contribute to improvement in quality and efficiency enhancement of Korean treatment of Alcohol Use Disorder.
Cooperative Behavior

In the present study, we performed immunohistochemical studies to investigate the detailed distribution of insulin-like growth factor binding protein 7 (IGFBP7) in the central nervous system of adult rats. Twelve adult (4~6 month old) Sprague-Dawley rats were examined in this study. Immunohistochemistry using specific antibodies against IGFBP7 was performed in accordance with the free-floating method. In the present study, IGFBP7 immunoreactivity was observed in the cerebral cortex, hippocampus, brainstem, cerebellum and spinal cord. In the cerebral cortex, heavily stained neurons were seen in layers II-VI. In the hippocampus, pyramidal cells in CA1-3 region were strongly immunoreactive for IGFBP7. Strong immunoreactive neurons were also found in the supraoptic nucleus, paraventricular nucleus, periaqueductal gray and oculomotor nucleus. In the cerebellum, IGFBP7 immunoreactivity was prominent in the Purkinje cells and cerebellar output neurons. IGFBP7-immunoreactive neurons were prominent in the superior vestibular nucleus, cochlear nucleus, trigeminal motor nucleus, nucleus of the trapezoid, and facial nucleus. IGFBP7-immunoreactive neurons were also observed mainly in the anterior horn of the spinal cord. The first demonstration of IGFBP7 localization in the whole brain may provide useful data for the future investigations on the structural and functional properties of IGFBP7.
Adult ; Animals ; Antibodies ; Brain ; Brain Stem ; Carrier Proteins ; Central Nervous System ; Cerebellum ; Cerebral Cortex ; Cochlear Nucleus ; Hippocampus ; Horns ; Humans ; Immunohistochemistry ; Neurons ; Paraventricular Hypothalamic Nucleus ; Periaqueductal Gray ; Purkinje Cells ; Pyramidal Cells ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; Supraoptic Nucleus ; Trigeminal Nuclei

Chrome may have a corrosive, necrotizing effect on tissue, so repeated skin contact to chromate might induce perforations or ulcers on the skin. This condition is called a "chrome ulcer" or "chrome hole". It appears as a small, punched-out mark with a rolled-out border. It is rarely associated with pain, but a severe itching sensation is common. We report a case of a 33-year-old man who presented with a 3 month history of several ulcers on his abdomen. He was employed at a chromate alloying process. He had several hole-like atrophic scars and unbearable pruritus. After changing his occupation, plus treatment with oral corticosteroids and antihistamines, the lesions were healed and the itching sensation faded away. However, atrophic scarring remained.
Abdomen ; Adrenal Cortex Hormones ; Adult ; Cicatrix ; Histamine Antagonists ; Humans ; Occupations ; Pruritus ; Sensation ; Skin ; Ulcer*

Vitiligo and morphea are two distinct entities of unknown etiology, although their existence implies that the immune system and/or the central or peripheral nervous system has been incriminated. Only a few reports of their simultaneous occurrence are on record. Here we report a case of a 39 year old woman affected with both vitiligo of the face, chest and hand and morphea of shoulder and trunk. Since the two diseases appeared after bone marrow transplantation, if could be deduced that there is a possible association between them. Two diseases observed simultaneously in this patient may be derived from the common pathomechanism. An autoimmune etiology is thought to play a part in both of these diseases.
Adult ; Bone Marrow Transplantation* ; Bone Marrow* ; Female ; Hand ; Humans ; Immune System ; Peripheral Nervous System ; Scleroderma, Localized ; Shoulder ; Thorax ; Vitiligo

Chronic exogenous steroid therapy can result in hypothalamic-pituitary-adrenal axis dysfunction; this usually results from systemic steroid therapy, and is rarely associated with topical steroid therapy. We report a case of suspected iatrogenic Cushing syndrome that developed after the treatment of annular pustular psoriasis. The patient applied clobetasol-17-propionate cream (Betabate(R)) 15~30 g daily, for 4 months, without a dermatologist's prescription. After 4 months of application, the following symptoms developed; a moon face; facial flushing; hypertrichosis; central obesity; purple striae; and multiple erythematous scaly annular patches. The development of Cushing syndrome from exogenous corticosteroid treatment was supported by the typical clinical manifestations and the low basal state of the blood cortisol level, which was perhaps due to secondary suppression of the hypothalamic pituitary-adrenal axis. Steroid-containing drugs, especially during childhood, should be used with caution and monitored carefully.
Axis, Cervical Vertebra ; Cushing Syndrome* ; Flushing ; Humans ; Hydrocortisone ; Hypertrichosis ; Obesity, Abdominal ; Prescriptions ; Psoriasis

Mesenteric panniculitis is an extremely rare inflammatory condition of the adipose tissue of unknown etiology. It is characterized by extensive, progressive fibrosis of the mesenteric fat tissue, leading to tumor formation. Clinical manifestations vary according to the process involving the structures. Abdominal pain accompanied by nausea, malaise, pyrexia, and weight loss and a poorly defined mass are common presentations. Major pathologic changes include (1) degeneration of mesenteric fat, (2) an inflammatory reaction, and (3) fibrosis of the adipose tissue. We present four patients with an aggressive form of mesenteric pannicultis with characteristic histopathologic features. We discuss the relationship between the histopathologic features and the surgical intervention in these cases.
Abdominal Pain ; Adipose Tissue ; Fever ; Fibrosis ; Humans ; Nausea ; Panniculitis, Peritoneal* ; Weight Loss

BACKGROUND AND OBJECTIVES : Microvascular integrity has been associated with the clinical outcomes in acute myocardial infarction (AMI). The present study was conducted to determine the value of many microvascular indexes assessed by an intracoronary (IC) pressure/Doppler wire in AMI following primary PCI for detecting viable myocardium by comparing with the 18F-fluorodeoxyglucose uptake rate (%FDG uptake) on positron-emission tomography (PET). SUBJECTS AND METHODS : We studied 35 patients who had their first AMI (age: 56+/-12, male: 30). After primary PCI, the TMPG (TIMI myocardial perfusion grade) was assessed. We measured the coronary flow reserve (CFR), the diastolic deceleration time (DDT), the coronary wedge pressure (Pcw), the Pcw/ Pa (mean aortic pressure) and the hyperemic microvascular resistance index (hMVRI) by an IC Doppler/ pressure wire. 18FDG PET scan was obtained at 7 days after the primary PCI; viable myocardium was defined that the %FDG uptake was more than 50% in infarct-related myocardium. RESULTS : There were significant correlations between TMPG, CFR, Pcw, Pcw/Pa, DDT, hMVRI and %FDG uptake (r=0.651, p<0.001; r=0.386, p=0.020; r=-0.388, p=0.021; r=-0.473, p=0.004; r=0.589, p<0.001; r=-0.442, p=0.008, respectively). The best cutoff values and area under curves (AUC) of the CFR, Pcw, Pcw/Pa, DDT and hMVRI for 50% FDG uptake were 1.8 (0.737), 27 mmHg (0.600), 0.33 (0.660), 600 msec (0.802) and 2.55 mmHg.cm-1.sec (0.768), respectively. The DDT had a significantly higher AUC than that of Pcw (p=0.029) and it was an independent index to predict the myocardial viability (p=0.011). CONCLUSION : DDT was the most reliable hemodynamic microvascular index that was assessed within 24 hours following primary PCI for predicting the viable myocardium in AMI patients.
Area Under Curve ; DDT ; Deceleration ; Fluorodeoxyglucose F18 ; Hemodynamics ; Humans ; Male ; Myocardial Infarction ; Myocardium ; Perfusion ; Positron-Emission Tomography ; Pulmonary Wedge Pressure

BACKGROUND: Loss of cardiomyocytes in the myocardial infarction leads to regional contractile dysfunction, and necrotized cardiomyocytes in infracted ventricular tissues are progressively replaced by fibroblasts forming scar tissue. Although cardiomyoplasty, or implantation of ventricular assist device or artificial heart was tried in refractory heart failure, the cardiac transplantation was the only therapeutic modality because these other therapeutic strategies were not permanent. Cell transplantation is tried instead of cardiac transplantation, especially bone marrow is the most popular donated organ. But because bone marrow aspiration procedure is invasive and painful, and it had the fewer amounts of cellular population, the adipose tissue is recommended for harvesting of mesenchymal stem cells. MATERIAL AND METHOD: After adipose tissues were extracted from abdominal subcutaneous adipose tissue and intra-abdominal adipose tissue individually, the cellular components were obtained by same method. These cellular components were tried to transformation with the various titers of 5-azacytidine to descript the appropriate concentration of 5-azacytidine and possibility of transformation ability of adipose tissue. Group 1 is abdominal subcutaneous adipose tissue and Group 2 is intra-abdominal adipose tissue-retroperitoneal adipose tissue and omentum. Cellular components were extracted by collagenase and NH4Cl et al, and these components were cultured by non-induction media-DMEM media containing 10% FBS and inducted by none, 3 micromol/L, 6 micromol/L, and 9 micromol/L 5-azacytidine after the 1st and 2nd subculture. After 4 weeks incubation, the cell blocks were made, immunostaining was done with the antibodies of CD34, heavy myosin chain, troponin T, and SMA. RESULT: Immunostaining of the transformed cells for troponin T was positive in the 6 micromol/L & 9 micromol/L 5-azacytidine of Group 1 & 2, but CD34 and heavy myosin chain antibodies were negative and SMA antibody was positive in the 3 micromol/L & 6 micromol/L 5-azacytidne of Group 2. CONCLUSION: These observations confirm that adult mesenchymal stem cells isolated from the abdominal subcutaneous adipose tissues and intra-abdominal adipose tissues can be chemically transformed into cardiomyocytes. This can potentially be a source of autologous cells for myocardial repair.
Adipose Tissue ; Adult* ; Animals ; Antibodies ; Azacitidine* ; Bone Marrow ; Cardiomyoplasty ; Cell Transplantation ; Cicatrix ; Collagenases ; Fibroblasts ; Heart Failure ; Heart Transplantation ; Heart, Artificial ; Heart-Assist Devices ; Humans ; Intra-Abdominal Fat ; Mesenchymal Stromal Cells* ; Myocardial Infarction ; Myocytes, Cardiac* ; Myosins ; Omentum ; Rats* ; Subcutaneous Fat, Abdominal ; Transplants ; Troponin T

OBJECTIVE: The purpose of this study was to evaluate the survival rate of vitrified blastocyst according to the freezing vessels, equilibration time in cryoprotectant and artificial dehydration method. METHODS: Human blastocysts were vitrified after loading onto the plastic straw, open-pulled straw (OPS), electron microscopy grid (EM grid) for 1.5 min or 3 min. They also were directly plunged into LN2 within 30sec. For artificial shrinkage of blastocysts, 36 gauge fine needle was pushed at the cellular junction of the trophectoderm into the blstocoele cavity until it shrank without damage of inner cell mass. RESULTS: The survival rate of vitrified blastocysts on plastic straw, OPS, EM grid as freezing vessels were 26.7, 13.0 and 60.5%, respectively. The survival rate of EM grid was significantly higher than that of plastic straw and OPS (p<0.05). For 1.5 min equilibrium, the survival rates of early blastocyst (EB), middle blastocyst (MB) and late blastocyst (LB) were 64.4, 81.0, and 20.0% respectively. For 3 min equilibrium, the survival rates of EB, MB, and LB were 69.9, 50.0 and 57.5% respectively. The survival rates of EB and MB were significantly higher than that of LB in 1.5 min equilibrium group (p<0.05), however, the significance was not observed in 3 min equilibrium groups. In cytoplasmic shrinkage before vitrification, the survival rates of EB, MB and LB were 92.9, 100 and 75.9% respectively. The survival rate of MB was significantly higher than that of LB (p<0.05). The survival rates of vitrified blastocysts by artificial dehydration and slow-frozen blastocysts were not significantly different as 88.9 and 66.7%, respectively. CONCLUSION: This study showed that the vitrification of human blastocysts using EM grid and artificial dehydration is an effective method. Therefore, these methods would be an useful techniques for blastocyst cryopreservation.
Blastocyst* ; Cryopreservation ; Cytoplasm ; Dehydration ; Freezing ; Humans* ; Microscopy, Electron ; Needles ; Plastics ; Survival Rate ; Vitrification*