White Matter Alterations Associated with Pro-inflammatory Cytokines in Patients with Major Depressive Disorder

Objective@#Regarding the neuroinflammatory theory of major depressive disorder (MDD), little is known about the effect of pro-inflammatory cytokines on white matter (WM) changes in MDD. We aimed to investigate the relationship between pro-inflammatory cytokines and WM alterations in patients with MDD. @*Methods@#Twenty-two patients with MDD and 22 healthy controls (HC) were evaluated for brain imaging and pro-inflammatory cytokines including interleukin (IL)-1β, IL-6, IL-8, interferon-γ and tumor necrosis factor (TNF)-α. Tract-based spatial statistics and FreeSurfer were used for brain image analysis. @*Results@#The levels of TNF-αand IL-8 were significantly higher in the MDD group than in HC. Compared to HC, lower fractional anisotropy (FA), and higher median diffusivity (MD) and radial diffusivity (RD) values were found in the MDD group for several WM regions. Voxel-wise correlation analysis showed that the level of TNF-α was negatively correlated with FA, and positively correlated with MD and RD in the left body and genu of the corpus callosum, left anterior corona radiata, and left superior corona radiata. @*Conclusion@#Our findings suggest that TNF-α may play an important role in the WM alterations in depression, possibly through demyelination.

White Matter Alterations Associated with Pro-inflammatory Cytokines in Patients with Major Depressive Disorder

Objective@#Regarding the neuroinflammatory theory of major depressive disorder (MDD), little is known about the effect of pro-inflammatory cytokines on white matter (WM) changes in MDD. We aimed to investigate the relationship between pro-inflammatory cytokines and WM alterations in patients with MDD. @*Methods@#Twenty-two patients with MDD and 22 healthy controls (HC) were evaluated for brain imaging and pro-inflammatory cytokines including interleukin (IL)-1β, IL-6, IL-8, interferon-γ and tumor necrosis factor (TNF)-α. Tract-based spatial statistics and FreeSurfer were used for brain image analysis. @*Results@#The levels of TNF-αand IL-8 were significantly higher in the MDD group than in HC. Compared to HC, lower fractional anisotropy (FA), and higher median diffusivity (MD) and radial diffusivity (RD) values were found in the MDD group for several WM regions. Voxel-wise correlation analysis showed that the level of TNF-α was negatively correlated with FA, and positively correlated with MD and RD in the left body and genu of the corpus callosum, left anterior corona radiata, and left superior corona radiata. @*Conclusion@#Our findings suggest that TNF-α may play an important role in the WM alterations in depression, possibly through demyelination.

Closure of oroantral fistula: a review of local flap techniques

Oroantral fistula (OAF), also termed oroantral communication, is an abnormal condition in which there is a communicating tract between the maxillary sinus and the oral cavity. The most common causes of this pathological communication are known to be dental implant surgery and extraction of posterior maxillary teeth. The purpose of this article is to describe OAF; introduce the approach algorithm for the treatment of OAF; and review the fundamental surgical techniques for fistula closure with their advantages and disadvantages. The author included a thorough review of the previous studies acquired from the PubMed database. Based on this review, this article presents cases of OAF patients treated with buccal flap, buccal fat pad (BFP), and palatal rotational flap techniques.

Closure of oroantral fistula: a review of local flap techniques

Oroantral fistula (OAF), also termed oroantral communication, is an abnormal condition in which there is a communicating tract between the maxillary sinus and the oral cavity. The most common causes of this pathological communication are known to be dental implant surgery and extraction of posterior maxillary teeth. The purpose of this article is to describe OAF; introduce the approach algorithm for the treatment of OAF; and review the fundamental surgical techniques for fistula closure with their advantages and disadvantages. The author included a thorough review of the previous studies acquired from the PubMed database. Based on this review, this article presents cases of OAF patients treated with buccal flap, buccal fat pad (BFP), and palatal rotational flap techniques.

Closure of oroantral fistula: a review of local flap techniques

Oroantral fistula (OAF), also termed oroantral communication, is an abnormal condition in which there is a communicating tract between the maxillary sinus and the oral cavity. The most common causes of this pathological communication are known to be dental implant surgery and extraction of posterior maxillary teeth. The purpose of this article is to describe OAF; introduce the approach algorithm for the treatment of OAF; and review the fundamental surgical techniques for fistula closure with their advantages and disadvantages. The author included a thorough review of the previous studies acquired from the PubMed database. Based on this review, this article presents cases of OAF patients treated with buccal flap, buccal fat pad (BFP), and palatal rotational flap techniques.

Effects of Uric Acid on the Alterations of White Matter Connectivity in Patients with Major Depression

OBJECTIVE: Uric acid is a non-enzymatic antioxidant associated with depression. Despite its known protective role in other brain disorders, little is known about its influence on the structural characteristics of brains of patients with major depressive disorder (MDD). This study explored the association between uric acid and characteristics of white matter (WM) in patients with MDD. METHODS: A total of 32 patients with MDD and 23 healthy controls (HCs) were examined. All participants were scored based on the Beck Depression Inventory and Beck Anxiety Inventory at baseline. All patients were also rated with the Hamilton Depression Rating Scale. We collected blood samples from all participants immediately after their enrollment and before the initiation of antidepressants in case of patients. Tract-based spatial statistics were used for all imaging analyses. RESULTS: Lower fractional anisotropy (FA) and higher radial diffusivity (RD) values were found in the MDD group than in the HC group. Voxelwise correlation analysis revealed that the serum uric acid levels positively correlated with the FA and negatively with the RD in WM regions that previously showed significant group differences in the MDD group. The correlated areas were located in the left anterior corona radiata, left frontal lobe WM, and left anterior cingulate cortex WM. CONCLUSION: The present study suggests a significant association between altered WM connectivity and serum uric acid levels in patients with MDD, possibly through demyelination.

Erratum: Effects of Uric Acid on the Alterations of White Matter Connectivity in Patients with Major Depression

The authors discovered that the p-value for group difference in sex (male/female) in Table 1 was incorrect. And the authors described unclearly whether the p-value for the sex distribution was obtained by chi-square test or Fisher's exact test.

Atraumatic Bilateral Fracture of the Femoral Neck in Young Male Patient with Suspected Osteomalacia

In this report, we describe the case of a healthy 37-year-old male patient without a history of disease, who developed atraumatic bilateral fracture of the femoral neck. Radiological and blood investigations revealed osteopenia and severe vitamin D deficiency (7.42 ng/mL), respectively, but patient had no apparent risk factors for insufficiency fracture. Bilateral osteosynthesis was obtained using cannulated screws and laboratory findings improved after vitamin D supplementation. This case highlights the effect of vitamin D deficiency on demineralization in a young male patient.

The Methods for Foot Function Index and Foot and Ankle Outcome Score Measurement: A Comparison between Paper-and-Pencil Method and Electronic Method / 대한족부족관절학회지

PURPOSE: The patient-reported outcome measure (PROM) is used to quantify the subjective state of patients before and after the treatment. The electronic method was recently developed and used for the completion of PROM, in addition to the conventional paper and pencil method. This study identified whether the results of Foot Function Index (FFI) and Foot and Ankle Outcome Score (FAOS) using the paper and pencil method was different from those using the electronic method. MATERIALS AND METHODS: Between May 2016 and August 2016, 42 patients who were admitted to the Seoul Foot and Ankle Center two days before surgery were included for evaluation. The mean age was 46 years (range, 21~72 years). There were 29 males and 13 females. To use the electronic method, the PADAS software (PADAS, Seoul, Korea) was implemented using a touch pad. The primary trial of FFI and FAOS was performed using either the paper-and-pencil method or the electronic method. At 24 hours after the primary test, a secondary trial of FFI and FAOS was performed using the other method. Then, we identified the reliability of FFI and FAOS between the two methods by calculating the intraclass coefficient. RESULTS: Twenty-two patients underwent the first trial using the paper-and-pencil method, and 20 patients underwent the first trial using the electronic method. Of the 42 patients, 8 patients were excluded from this study and only 34 patients were included in this study. The reliability of FFI was excellent with an intraclass coefficient of 0.957, and the reliability of FAOS was also excellent with an intraclass coefficient of 0.840. CONCLUSION: The paper-and-pencil method and the electronic method have the same result for the completion of FFI and FAOS in this study. Therefore, it is commonly considered that the completion of FFI and FAOS using the electronic method can be applied in practice.

Association of Plasma Levels of Angiotensin-Converting Enzyme and Cytokines with Recurrent Depression : A Preliminary Study

OBJECTIVES: Angiotensin-converting enzyme (ACE) gene and plasma levels of cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), have previously been determined to be associated with depression. The purpose of this study was to investigate the association of plasma levels of ACE and cytokines with recurrent depression. METHODS: A total of 52 participants (14 male, 38 female, aged 43.9 ± 14.0 years) were enrolled after being diagnosed with depression by experienced psychiatrists using the Mini International Neuropsychiatric Interview from the outpatient clinic of the Department of Psychiatry, CHA Bundang Medical Center. The participants completed blood sampling, the Hamilton Depression Rating Scale (HAMD), the Beck Depression Inventory, the Beck Anxiety Inventory, and the Scale for Suicidal Ideation. RESULTS: ACE plasma levels are higher in patients with recurrent depression (27.4 ± 10.4 U/L) than in patients with newly diagnosed depression (19.1 ± 7.7 U/L) (p = 0.004). The levels of cytokines, such as TNF-α, IL-4, IL-6, IL-10, are not significantly different between the two groups. Additionally, the ACE plasma level is negatively correlated with a reduction in the HAMD over six weeks (r = −0.429, p = 0.046, n = 22). CONCLUSIONS: The current findings show that plasma ACE levels may be associated with recurrent depression and further suggest that the renin-angiotensin system could play a role in recurrent depression.

Central Nervous System-Peripheral Immune System Dialogue in Neurological Disorders: Possible Application of Neuroimmunology in Urology / 대한배뇨장애요실금학회지

Previous concepts of immune-privileged sites obscured the role of peripheral immune cells in neurological disorders and excluded the consideration of the potential benefits of immunotherapy. Recently, however, numerous studies have demonstrated that the blood-brain barrier in the central nervous system is an educational barrier rather than an absolute barrier to peripheral immune cells. Emerging knowledge of immune-privileged sites suggests that peripheral immune cells can infiltrate these sites via educative gates and that crosstalk can occur between infiltrating immune cells and the central nervous system parenchyma. This concept can be expanded to the testis, which has long been considered an immune-privileged site, and to neurogenic bladder dysfunction. Thus, we propose that the relationship between peripheral immune cells, the brain, and the urologic system should be considered as an additional possible mechanism in urologic diseases, and that immunotherapy might be an alternative therapeutic strategy in treating neurogenic bladder dysfunction.

Clinical Analysis of the Conservative Treatment for Diabetic Foot Osteomyelitis / 대한족부족관절학회지

PURPOSE: The question of surgical versus non-surgical treatment for diabetic foot osteomyelitis remains subject to debate. The aims of this study were to analyse the outcome of conservative treatment (antibiotic treatment and conservative surgery) for diabetic foot osteomyelitis and identify the predictive factors of remission in conservative treatment of diabetic foot osteomyelitis. MATERIALS AND METHODS: Seventy-seven patients with diabetic foot osteomyelitis who initially received conservative treatment from January 2004 to July 2013 were identified, and their medical records were reviewed. Diabetic foot osteomyelitis was defined by imaging studies or histological evidence. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 12 months after the end of treatment. The demographic, clinical, and therapeutic factors were analysed. RESULTS: The mean age of the patients was 62.7+/-12.2 years, and 47 patients (61.0%) were male. The median diabetes duration was 15.7+/-11.2 years and mean HbA1c was 8.7%+/-2.4%. Forty-eight patients (62.3%) healed with conservative treatment (antibiotic treatment and conservative surgery). Twenty-five patients (32.5%) underwent amputation. In the multivariate analysis, concomitant peripheral artery disease and inadequate antibiotic therapy were associated with failure of conservative treatment. CONCLUSION: Antibiotics alone, or with conservative surgery, were successful in treatment of diabetic foot osteomyelitis in 62.3% of the patients. Concomitant peripheral artery disease and inadequate antimicrobial therapy were risk factors for remission in conservatively treated diabetic foot osteomyelitis.

Neuroprotective Effect of Visnagin on Kainic Acid-induced Neuronal Cell Death in the Mice Hippocampus

Visnagin (4-methoxy-7-methyl-5H-furo[3,2-g][1]-benzopyran-5-one), which is an active principle extracted from the fruits of Ammi visnaga, has been used as a treatment for low blood-pressure and blocked blood vessel contraction by inhibition of calcium influx into blood cells. However, the neuroprotective effect of visnagin was not clearly known until now. Thus, we investigated whether visnagin has a neuroprotective effect against kainic acid (KA)-induced neuronal cell death. In the cresyl violet staining, pre-treatment or post-treatment visnagin (100 mg/kg, p.o. or i.p.) showed a neuroprotective effect on KA (0.1 microgram) toxicity. KA-induced gliosis and proinflammatory marker (IL-1beta, TNF-alpha, IL-6, and COX-2) inductions were also suppressed by visnagin administration. These results suggest that visnagin has a neuroprotective effect in terms of suppressing KA-induced pathogenesis in the brain, and that these neuroprotective effects are associated with its anti-inflammatory effects.

Tubal pregnancy with accessory fallopian tube: A case report / 대한산부인과학회지

Mullerian duct anomalies are reported in literature, but maldevelopment of fallopian tube in isolation is rare. Accessory fallopian tubes can present as infertility, ectopic pregnancy, in association with urinary tract anomalies. We observed a case of tubal pregnancy where fallopian tube has two fimbriae with normal looking uterine and fallopian tube on the opposite side. we report a case of tubal pregnancy with accessory fallopian tube with literature review.

Tubal pregnancy with accessory fallopian tube: A case report / 대한산부인과학회지

Mullerian duct anomalies are reported in literature, but maldevelopment of fallopian tube in isolation is rare. Accessory fallopian tubes can present as infertility, ectopic pregnancy, in association with urinary tract anomalies. We observed a case of tubal pregnancy where fallopian tube has two fimbriae with normal looking uterine and fallopian tube on the opposite side. we report a case of tubal pregnancy with accessory fallopian tube with literature review.

A case of primary ovarian leiomyoma / 부인종양

Ovarian leiomyoma is a rare type of tumor that only takes about 1% of benign ovarian tumor. It mostly does not induce any symptoms and is often found by chance during a surgical operation in abdominal cavity. It is microscopically observed that smooth muscle cells with an identical shape and a small nucleus grow in a bundle or in a storiform configuration, and they need to be distinguished from other tumors of the smooth-muscle origin that can occur in ovary such as fibroma/thecoma and extragastrointestinal stromal tumor. Using immunohistochemistry staining on desmin, smooth muscle actin (SMA), alpha-inhibin, c-kit, etc can help with distinguishing these tumors. Recently, the authors experienced in this hospital a primary ovarian leiomyoma of a 43-year-old female patient and hereby report the case with a review of literatures.

A case of parovarian tumor of borderline malignancy / 부인종양

Parovarian cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. Due to the rarity of this lesion, there are controversies concerning the origin, clinical behavior, treatment and prognosis of these tumors. Parovarian borderline malignancy mostly occur in young women, main complaints are abdominal enlargement and pelvic pain. we experienced one case of parovarian borderline malignancy and report this case with a brief review of literature.

Uterine abscess after radiofrequency myolysis of uterine myoma: A case report / 대한산부인과학회지

Radiofrequency myolysis is a method for preserving uterus and fecundity, and due to its more non-invasive and simpler operation, it is now frequently carried out to cure the uterine myomas. However, not long time has passed since this operation started, and little studies were conducted on its complications and side effects. Therefore, since the authors experienced the formation of an abscess in uterus after radiofrequency myolysis of uterine myoma, we hereby report the case.

Role of gamma-aminobutyric acid B (GABA B) receptors in the regulation of kainic acid-induced cell death in mouse hippocampus

Kainic acid (KA) is well-known as an excitatory, neurotoxic substance. In mice, KA administered intracerebroventricularly (i.c.v.) lead to morphological damage of hippocampus expecially concentrated on the CA3 pyramidal neurons. In the present study, the possible role of gamma-aminobutyric acid B (GABA B) receptors in hippocampal cell death induced by KA (0.1 microgram) administered i.c.v. was examined. 5-Aminovaleric acid (5-AV; GABA B receptors antagonist, 20 microgram) reduced KA-induced CA3 pyramidal cell death. KA increased the phosphorylated extracellular signal-regulated kinase (p-ERK) and Ca2+ /calmodulin-dependent protein kinase II (p-CaMK II) immunoreactivities (IRs) 30 min after KA treatment, and c-Fos, c-Jun IR 2 h, and glial fibrillary acidic protein (GFAP), complement receptor type 3 (OX-42) IR 1 day in hippocampal area in KA-injected mice. 5-AV attenuated KA-induced p-CaMK II, GFAP and OX-42 IR in the hippocampal CA3 region. These results suggest that p-CaMK II may play as an important regulator on hippocampal cell death induced by KA administered i.c.v. in mice. Activated astrocytes, which was presented by GFAP IR, and activated microglia, which was presented by the OX-42 IR, may be a good indicator for measuring the cell death in hippocampal regions by KA excitotoxicity. Furthermore, it showed that GABA B receptors appear to be involved in hippocampal CA3 pyramidal cell death induced by KA administered i.c.v. in mice.

Effect of Cyclosporine, Mycophenolic Acid, and Rapamycin on the Proliferation of Rat Aortic Vascular Smooth Muscle Cells: in Vitro Study / 대한이식학회지

Proliferative and obliterative arteriopathy resulting ischemic end organ dysfunction is the main histologic feature of chronic rejection after organ transplantation. This vascular narrowing and intimal hyperplasia produced by chronic rejection is one of the major factor that limits long-term survival after solid organ transplantation. At present, effective prophylactic and therapeutic strategies for chronic rejection is still missing. The proliferation and migration of smooth muscle cells and finally deposition of extracellular matrix account for much of the arterial intimal thickening in organ allografts. In vivo animal models of hyperplastic vascular luminal narrowing induced by allogeneic or mechanical injury to the vasculature indicate that certain immunosuppressive drugs have inhibitory properties on smooth muscle cell proliferation. This study summarizes the inhibitory effects of different immunosuppressive drugs in vitro on the growth factor-induced proliferation of vascular smooth muscle cells isolated from rat aorta. Rapamycin and mycophenolic acid potently inhibited the proliferation of vascular smooth muscle cells at clinically attainable concentration, individually. Cyclosporine showed limited inhibition of smooth muscle cell proliferation, but the inhibitory concentration50 (IC50) values were just below cytotoxic levels. Therefore these direct antiproliferative action on vascular smooth muscle cells by rapamycin or mycophenolic acid, in vitro, may prevent the development of arterial intimal thickening associated with chronic rejection.