Nutcracker syndrome is caused by external compression of the left renal vein and is characterized by various symptoms, such as hematuria and left flank pain. However, long-standing gross hematuria is uncommon. We report the case of a 23-year-old woman who had had painless gross hematuria for several months. Kidney biopsy revealed thin basement membrane disease, but this did not explain the gross hematuria with proteinuria. Renal venography and Doppler ultrasonography showed increased diameter and velocity ratios between the left renal vein and inferior vena cava. Cystoscopy revealed that the hematuria originated from the left ureteral orifice. These results indicate coexisting Nutcracker syndrome. Nutcracker syndrome with thin basement membrane disease should be considered in the differential diagnosis of a patient who has long-standing gross hematuria.

Objectives: During Le Fort I osteotomy, the separation of the pterygomaxillary junction (PMJ) is a difficult procedure for most surgeons because it is invisible. In this process, damage to the posterior structures constituting the sinus or those adjacent to it, including the maxillary sinus posterior wall and pterygoid plate, may occur. We would like to investigate the effects of this on the inside of the maxillary sinus after surgery and whether there are complications. Materials and Methods: One-hundred patients who underwent Le Fort I osteotomy from 2013 to 2020 using cone-beam computed tomography images were classified into two groups (clean-cut type and fractured type) according to the PMJ cutting pattern. In addition, the mucosal thickness in the maxillary sinus was divided into preoperative, postoperative three months, one year, and the change over the course of surgery was evaluated retrospectively. Results: Of the total 100 cases, the clean-cut type numbered 28 cases and the fractured type totaled 72 cases. Among the fracture types, part of the sinus wall and the pterygoid plate were broken in 69 cases, and the maxillary sinus posterior wall was detached in three cases. There was no statistically significant difference in sinus mucosal thickening between the clean-cut type and fractured type of the PMJ, three months and one year after surgery between the two groups. However, there was a significant difference in sinus mucosal thickness at postoperative one year in the case where a partial detachment of the maxillary sinus posterior wall occurred compared to not. Conclusion Even if there is some damage to the structures behind the PMJ, it may not be reasonable to spend some time on the PMJ separation process considering the overall postoperative complications, if there is no significant difference inside the sinus, or increased probability of postoperative complications.

Hyperparathyroidism is common in patients with chronic kidney disease with reduced renal function and has been observed after kidney transplantation. The optimal treatment for cases in which hyperparathyroidism persists after kidney transplantation has not been determined. Methods: This retrospective study included 83 patients with tertiary hyperparathyroidism who underwent kidney transplantation between 2000 and 2018 at a single tertiary center in Korea. Sixty-four patients underwent parathyroidectomy and 19 patients were treated with cinacalcet following renal transplantation. Biochemical parameters and clinical outcomes were compared between the two groups. Results: Serum calcium and parathyroid hormone (PTH) levels improved in both the parathyroidectomy and cinacalcet groups. One year after treatment, parathyroidectomy resulted in a lower mean serum calcium level than cinacalcet (9.7 ± 0.7 mg/dL vs. 10.5 ± 0.7 mg/dL, p = 0.001). Regarding serum PTH, the parathyroidectomy group showed a significantly lower PTH level than the cinacalcet group at 6 months (129.1 ± 80.3 pg/mL vs. 219.2 ± 92.5 pg/mL, p = 0.002) and 1 year (118.8 ± 75.5 pg/mL vs. 250.6 ± 94.5 pg/ mL, p < 0.001). There was no statistically significant difference in the incidence of kidney transplant rejection, graft failure, cardiovascular events, fracture risk, or bone mineral density changes between the two groups. Conclusion: Parathyroidectomy appears to reduce PTH and calcium levels effectively in tertiary hyperparathyroidism. However, creatinine level and allograft rejection should be monitored closely.

Autoantibodies ; COVID-19 ; Humans ; Singapore/epidemiology*

Background: Foreign bodies may be embedded or left behind in the oral cavity during oral surgical procedure. The loss of instruments such as impression material, surgical gauze, and broken injection needles are commonly reported in the dental field. These complications are generally symptomatic and show signs of inflammation, pain, and purulent discharge. Accidental breakage of suture needles is a rare but potentially dangerous event.Case presentation: In this report, we present one case of lost suture needle during the procedure of flap operation at local dental clinic and its successful removal under local/general anesthesia administration via CBCT with a help of two reference needles to localize the 6-0 nylon needle and consulting with the clinician. Conclusion CT scanning taken while mouth-closing may not be accurate with regard to real location measurement performed while mouth-opening. If so, other up-to-date radiographic devices and methods to retrieve a needle are recommended.

CRISPR/Cas9 genome editing systems have been established in a broad range of eukaryotic species. Herein, we report the first method for genetic engineering in pyogo (shiitake) mushrooms (Lentinula edodes) using CRISPR/Cas9. For in vivo expression of guide RNAs (gRNAs) targeting the mating-type gene HD1 (LeA1), we identified an endogenous LeU6 promoter in the L. edodes genome. We constructed a plasmid containing the LeU6 and glyceraldehyde-3-phosphate dehydrogenase (LeGPD) promoters to express the Cas9 protein. Among the eight gRNAs we tested, three successfully disrupted the LeA1 locus. Although the CRISPRCas9–induced alleles did not affect mating with compatible monokaryotic strains, disruption of the transcription levels of the downstream genes of LeHD1 and LeHD2 was detected.Based on this result, we present the first report of a simple and powerful genetic manipulation tool using the CRISPR/Cas9 toolbox for the scientifically and industrially important edible mushroom, L. edodes.

Objectives: This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy. Materials and Methods: All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively. Results: Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for Aʼ/ANS and Ls/Is (P<0.001) was significant; Aʼ/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation. Conclusion The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.

Objectives: This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy. Materials and Methods: All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively. Results: Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for Aʼ/ANS and Ls/Is (P<0.001) was significant; Aʼ/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation. Conclusion The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.

Sixteen genomic DNA simple sequence repeat (SSR) markers of Lentinula edodes were developed from 205 SSR motifs present in 46.1-Mb long L. edodes genome sequences. The number of alleles ranged from 3–14 and the major allele frequency was distributed from 0.17–0.96. The values of observed and expected heterozygosity ranged from 0.00–0.76 and 0.07–0.90, respectively. The polymorphic information content value ranged from 0.07–0.89. A dendrogram, based on 16 SSR markers clustered by the paired hierarchical clustering' method, showed that 33 shiitake cultivars could be divided into three major groups and successfully identified. These SSR markers will contribute to the efficient breeding of this species by providing diversity in shiitake varieties. Furthermore, the genomic information covered by the markers can provide a valuable resource for genetic linkage map construction, molecular mapping, and marker-assisted selection in the shiitake mushroom.
Alleles ; Breeding ; DNA* ; Gene Frequency ; Genetic Linkage ; Genetic Variation ; Genome ; Lentinula* ; Methods ; Microsatellite Repeats ; Shiitake Mushrooms*

Plummer-Vinson syndrome is characterized by dysphagia, iron deficiency anemia, and upper esophageal web. The associated symptoms can be resolved by administering iron supplements as well as by endoscopic intervention. Relapse in patients with Plummer-Vinson syndrome is very rare. We describe a case of a 42-year-old woman with Plummer-Vinson syndrome whose symptoms were successfully treated with endoscopic dilatation and iron supplementation at first admission; however, 1 year later, she revisited our hospital because of dysphagia. On second admission, investigations revealed esophageal web relapse in Plummer-Vinson syndrome. She was again successfully treated with endoscopic dilatation and iron supplementation. After first admission, her anemia was not normalized due to poor compliance and loss of follow-up. We experienced a case of esophageal web relapse due to uncorrected iron deficiency anemia in a patient with Plummer-Vinson syndrome. This experience indicates that continuous iron supplementation and long-term follow-up is important in patients with Plummer-Vinson syndrome.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Compliance ; Deglutition Disorders ; Dilatation ; Female ; Follow-Up Studies ; Humans ; Iron ; Plummer-Vinson Syndrome* ; Recurrence