Oral mucormycosis in patients with haematologic malignancies in a bone marrow transplant unit.

Mucormycosis is an aggressive and life-threatening opportunistic fungal infection, which predominantly affects immunocompromised patients. It typically manifests in rhinocerebral, pulmonary or disseminated forms in patients with immunosuppressive conditions. Mucormycosis limited to the oral cavity is rare, and to the best of our knowledge only seven cases have previously been reported in English literature. We present five consecutive cases of oral mucormycosis in patients with leukaemia, and provide a literature review.

Carpal tunnel syndrome: Clinical, electrophysiological, and ultrasonographic ratio after surgery.

INTRODUCTION: The aim of this study was to improve our understanding of the pathophysiology of carpal tunnel syndrome (CTS) and to highlight the ultrasonographic cross-sectional area (CSA) ratio as a tool for assessing outcomes by investigating postoperative changes. METHODS: Twenty-four individuals with CTS were evaluated using the Boston questionnaire, nerve conduction studies, and ultrasound, preoperatively and at 3 weeks and 3 months postoperatively. RESULTS: Improved symptom scores, decreased CSA, and decreased CSA ratio were observed in the first 3 weeks, but functional improvement was also observed after 3 weeks postoperatively. The ratios between the CSA at the sites of enlargement and unaffected areas correlated significantly with the Padua classification, although the coefficient was not superior to the coefficient of CSA at the maximal swelling site. CONCLUSIONS: Symptoms improved more rapidly than function after surgery. Measurement of the ultrasonographic CSA ratio may provide clinicians with a useful assessment tool after surgery.

Avoiding false-negative nerve conduction study in ulnar neuropathy at the elbow.

INTRODUCTION: Ulnar nerve displacement at the elbow causes overestimation of nerve conduction velocity. We hypothesized that this overestimation may cause false-negative results when the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) diagnostic criteria are used. METHODS: We investigated 9 cases of ulnar neuropathy at the elbow, all having ulnar nerve displacement confirmed by ultrasonography and meeting none or just one of the AANEM criteria with distance measurement by anatomic landmarks. First, the distance across the elbow segment was measured by anatomic landmarks, and then it was re-estimated by ultrasonography. RESULTS: Overestimated ulnar conduction velocity was corrected by 7.9 m/s. Three cases met none of the AANEM criteria before correction. After correction of overestimation, all cases met two of the AANEM criteria. CONCLUSION: This study highlights the importance of using ultrasonography to confirm the possibility of ulnar nerve displacement, especially when electrodiagnostic findings do not meet AANEM criteria in patients with suspected UNE.

Ultrasonographic evaluation of needle electromyography insertion into the tibialis posterior using a posterior approach.

OBJECTIVE: To estimate the safety window for needle insertion in the posterior approach to the tibialis posterior by ultrasonography, particularly in a clinical setting. DESIGN: Cross-sectional study. SETTING: University hospital. PARTICIPANTS: Healthy volunteers (108 legs, from 22 men and 32 women). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Distance between the tibia and neurovascular bundles in the posterior aspect of the tibia on a transverse ultrasonographic scan. RESULTS: The safety window at the midpoint was significantly larger than the upper third (0.62-2.16 cm, average 1.47 ± 0.38 cm vs 0.51-1.62 cm, average 1.16 ± 0.31 cm). The depth at the midpoint was significantly more shallow than the upper third (1.57-3.16 cm, average 2.31 ± 0.34 cm vs 1.76-3.66 cm, average 2.52 ± 0.38 cm). Body weight, height, tibial length, and leg circumference showed positive correlation with the safety window at both points. CONCLUSIONS: The midpoint may be more favorable than the upper third for needle insertion to the tibialis posterior with a posterior approach.

Traditional Korean Medicine as Collaborating Treatments with Conventional Treatments for Knee Osteoarthritis: A Protocol for a Systematic Review and Meta-Analysis.

BACKGROUND: Knee osteoarthritis (OA) is a degenerative disease of the joint cartilage with no definite treatment in the early stage. Several previous review studies have shown that alternative medical treatments, including acupuncture, moxibustion, and herbal medicines, are effective in improving the symptoms of the disease and the patient's quality of life. However, no systematic review study has shown the effectiveness of the combination of conventional and alternative therapies. Therefore, the aim of our study is to determine the most effective combination therapies and to provide evidence for the effectiveness and safety of integrated therapies. This article describes the protocol for the methods that will be applied in our systematic review. METHODS: We will conduct an electronic search of nine databases: PubMed, Embase, Cochrane, Google Scholar (first 100 articles), four Korean databases (KoreaMed, Korean Studies Information Service System, Research Information Service System, and Oriental Medicine Advanced Searching Integrated System), and one Chinese database (China National Knowledge Infrastructure). Only randomized controlled studies that reported on both conventional treatment (drugs and hyaluronic acid) and traditional Korean medicine (acupuncture, moxibustion, and herbal medicines) will be selected. The primary outcomes will be pain and function of the joint. The secondary outcomes will include pain relief duration, total effective rate, incidence of adverse events, and quality of life. We will assess the methodological quality of the included studies using the Cochrane risk of bias tool. For the meta-analysis, standardized mean differences and risk ratios with 95% confidence intervals will be applied for continuous and dichotomous data, respectively. RESULTS: This review will evaluate the effectiveness and safety of several Korean medicine treatments combined with conventional treatments for knee OA. CONCLUSION: Our review will provide a good foundation for the integrative treatment of knee OA.

Thread Embedded Acupuncture for Non-Specific Posterior Neck Pain: A PRISMA-Compliant Protocol for Systematic Review and Meta-Analysis.

PURPOSE: The prevalence of non-specific posterior neck pain (NPNP) has been increasing yearly. There are several treatments for NPNP, but in this review, we will focus on thread-embedded acupuncture (TEA). TEA is used in the Republic of Korea, Taiwan, and China for managing musculoskeletal diseases, obesity, and sequelae of facial palsy. However, there is insufficient evidence on its effectiveness and safety. This study aims to assess the efficacy and safety of TEA for NPNP. METHODS: We will search the following nine electronic databases, from their inception to May 2020: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Citation Information by the National Information infrastructure, Korean Studies Information Service System, National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, and Research Information Service System. Only randomized controlled trials of TEA for NPNP will be included. The methodological quality of the included trials will be assessed using the Cochrane risk-of bias tool. To conduct the meta-analysis, the risk ratio and mean difference with the 95% confidence interval will be used. Sensitivity analyses will be conducted based on this protocol. RESULTS: The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSION: The results of this study would provide the evidence of whether TEA can be effective for treating NPNP. REGISTRATION NUMBER: PROSPERO CRD42020188346.

Quality assessment of conventional and traditional oriental medicine clinical practice guidelines for knee osteoarthritis using AGREE II instrument.

INTRODUCTION: Knee osteoarthritis is a degenerative disease and its prevalence tends to increase. Clinical practice guidelines (CPGs) are evidence-based recommendations for treatment that help policymakers, practitioners, and patients make more appropriate and efficient decisions during the course of management. This study aimed to evaluate the quality of knee osteoarthritis CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. METHOD: The retrieval engines and websites were utilized from January 2010 to December 2020. The search words were "Clinical practice guideline" OR "Critical practice guideline" OR "guideline∗" AND "Osteoarthritis." The quality of the CPGs was independently examined by four appraisers using the AGREE II instrument. Consequently, the selected CPGs were graded as Classes A, B, and C according to the level of recommendation. RESULT: In this study, 13 CPGs for knee osteoarthritis were selected and evaluated qualitatively using the AGREE II instrument. The overall quality percentage score was as follows: clarity of presentation, 72.6%, scope and purpose, 62.6%, rigor of development, 54.2%, stakeholder investment, 50.5%, editorial independence, 46.5%, applicability, 22.5%. CONCLUSION: Auxiliary materials for the treatment process of knee OA should be supplemented in future revised versions for quality improvement of knee OA CPGs. Also, more evidence should be accumulated to support the recommendation of traditional oriental medical treatments in the clinical field. From the perspective of integrative medicine, along with conventional pharmacological treatment, exercise, weight loss, and acupuncture can be combined together in clinical situations.

Association between interleukin 6 promoter variants and chronic hepatitis B progression.

Interleukin 6 (IL6) plays an essential role in the regulation of immune response to chronic disease. In this study, the three known single nucleotide polymorphisms (SNPs) in the IL6 promoter region were genotyped in a large chronic hepatitis B cohort to evaluate the effects of IL6 promoter variants. The single base extension method was used for this genotyping. Haplotypes were constructed by the three SNPs in IL6. Allele frequencies were compared for; i) patients with chronic hepatitis (CH) and chronic carriers vs. chronic hepatis patients with clinical evidence of liver cirrhosis (LC) (i.e., portal hypertension), ii) cirrhotic patients with hepatocellular carcinoma (HCC) vs. without HCC by logistic regression, and iii) with respect to the time intervals from the onset of infection to HCC. Results were analyzed by Cox relative hazard analysis on the assumption that all the patients were infected during early infancy. The frequencies of each SNP were 0.002 (IL6-597 G>A), 0.25 (IL6-572 C>G) and 0.002 (IL6-174 G>C), respectively, in the Korean population (n = 1,046). No significant associations were detected between IL6-572 C>G and chronic hepatitis B outcome in this study; i.e., LC occurrence on CH (OR = 0.16-1.27, P = 0.13- 0.71) and HCC occurrence on LC (OR = 1.04-1.23, P = 0.89-0.60) of heterozygotes and homozygotes for G allele in referent comparison to homozygotes for common allele (C/C genotype), and time interval to HCC (RH = 0.67-1.00; P = 0.14-0.99). In conclusion, there appeared to be no significant associations between IL6 promoter variants and disease outcome in chronic hepatitis B.

Association of transforming growth factor-beta1 gene polymorphisms with a hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection.

Transforming growth factor-beta1 (TGF-beta1) can act as both a tumor suppressor and a stimulator of tumor progression. We have examined the relationship between polymorphisms of the TGF-beta1 gene and the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection. A total of 1,237 Korean subjects were prospectively enrolled; 1,046 patients with chronic HBV infection and 191 healthy controls with no evidence of recent or remote HBV infection. The patients were divided into two groups: those without (n = 809) and those with HCC (n = 237). Single nucleotide polymorphisms (SNPs) of TGF-beta1 were searched for and genotyped using the single base extension method. In Korean subjects, only two SNPs were found among the seven known polymorphisms of TGF-beta1, at position -509 and in codon 10. The risk of HCC was significantly lower in patients with the T/T or C/T genotypes than in those with the C/C genotypes at position -509 (P < 0.02), and also lower among those with the Pro/Pro or Leu/Pro genotypes than in those with the Leu/Leu genotypes in codon 10 (P < 0.007). Haplotype analysis revealed that the possession of [-509C > T; L10P] conferred a decreased likelihood of HCC (OR = 0.74; 95% CI, 0.59-0.93; P = 0.008). In conclusion, the presence of the TGF-beta1 -509C > T promoter or of the L10P polymorphism, and the combination of both [-509C > T; L10P] as a haplotype were strongly associated with a reduced risk of HCC in patients with chronic HBV infection.

Effect of repetitive transcranial magnetic stimulation in a patient with chronic crossed aphasia: fMRI study.

OBJECTIVE: We report here the case of a 52-year-old Korean woman who was initially diagnosed with non-fluent/global crossed aphasia. METHODS AND RESULTS: Initial computed tomography of the brain revealed a haematoma of approximately 40 ml in the right basal ganglia area and cavitation around the right lateral ventricle. Three years after onset the aphasia was resolved to a conduction aphasia and she had an ongoing left-sided gait disturbance. Follow-up anatomical magnetic resonance imaging found no recurrence of haemorrhage. Language functional magnetic resonance imaging was examined before and after repetitive transcranial magnetic stimulation treatment. A 90-mm round coil stimulator was used and the repetitive transcranial magnetic stimulation treatment location was P3 on the 10-20 International electrode placement system (1 Hz, 20 min per day for 10 days over a 2-week period). Functional magnetic resonance imaging results before repetitive transcranial magnetic stimulation treatment showed no significant activity in either the ipsilesional or contralesional hemispheres for noun generation and sentence completion paradigms (p < 0.001, cluster size 128). Compared with the pre-treatment phase, following repetitive transcranial magnetic stimulation treatment the data from functional magnetic resonance imaging revealed significant activations in the right inferior frontal lobe (Broca's area), posterior temporal gyrus (Wernicke's area), and parietal lobe for both the noun generation and sentence completion tasks (p < 0.001, cluster size 128). CONCLUSION: This functional magnetic resonance imaging case study is the first to suggest the use of repetitive transcranial magnetic stimulation for improving language outcome in a patient with crossed aphasia. In addition, we report the value of language functional magnetic resonance imaging before and after repetitive transcranial magnetic stimulation treatment for determining the effect of treatment and the underlying neurobiological mechanism of functional recovery following repetitive transcranial magnetic stimulation treatment.

Interleukin 10 haplotype associated with increased risk of hepatocellular carcinoma.

Interleukin 10 (IL10) is a powerful Th-2 cell cytokine produced by lymphoid cells that exerts its functions by inhibiting macrophage/monocyte and T-cell lymphocyte replication and secretion of inflammatory cytokines (IL1, TNFA, TGFB, IL6, IL8 and IL12). Genetic association analysis of a well-characterized HBV cohort revealed that one of IL10 haplotypes, IL10-ht2, was strongly associated with hepatocellular carcinoma (HCC) occurrence in gene dose-dependent manner. The frequency of susceptible IL10-ht2 was much higher in HCC patients and significantly increased in order of susceptibility to HBV progression from chronic hepatitis to liver cirrhosis and HCC among hepatitis B patients. In addition, survival analysis clearly showed that the onset age of HCC was also accelerated among chronic hepatitis B patients who were carrying IL10-ht2. Increased IL10 production mediated by IL10-ht2 suggests that up-regulated IL10 accelerates progression of chronic HBV infection, especially to HCC development.

Association of interleukin-6 promoter variant with bone mineral density in pre-menopausal women.

Interleukin-6 (IL6) has many roles essential to the regulation of the immune response, hematopoiesis, and bone resorption. Three single-nucleotide polymorphisms (SNP) in the IL6 promoter region were genotyped by the single-base extension method. The frequencies of each SNP were 0.002 ( IL6-597 G--> A), 0.27 ( IL6-572 G--> C), and 0.002 ( IL6-174 G--> C) in a Korean population ( n=1,082). IL6-597 G--> A and IL6-174 G--> C were totally linked together ( d(2)=1) and showed very low allele frequencies (0.002), which are common in Caucasians. On the other hand, the frequency of the IL6-572 G--> C*C allele was much higher (0.27) than that in Caucasian populations (<0.07). One of the IL6 promoter SNPs, viz., IL6-572 G--> C, showed significant associations with bone mineral density (BMD), i.e., the C allele was associated with increased BMD ( P=0.02, co-dominant model; P=0.007, dominant model). The mean BMD was highest in homozygous C individuals (0.67+/-0.15), lowest in homozygous G individuals (0.58+/-0.19), and intermediate in heterozygotes (0.64+/-0.21). In the present study, we describe a variant in the IL6 promoter region that shows positive association with higher BMD in a gene-dose-dependent manner in pre-menopausal women.

Association of Eotaxin gene family with asthma and serum total IgE.

The Eotaxin gene family (Eotaxin1, Eotaxin2 and Eotaxin3) recruits and activates CCR3-bearing cells such as eosinophils, mast cells and Th2 lymphocytes that play a major role in allergic disorders. To date, the effect of polymorphisms of Eotaxin genes on asthma phenotypes has not been thoroughly examined. In our research, we sequenced whole regions of the Eotaxin gene family to identify polymorphisms, which may be involved in the development of asthma and total serum IgE. We have identified 37 SNPs in the Exotaxin gene family (Exotaxin1, 2 and 3), and 17 common polymorphic sites were selected for genotyping in our asthma cohort (n=721). Statistical analysis revealed that the EOT2+1265A>G G* allele showed significantly lower frequency in asthmatics than in normal healthy controls (0.14 versus 0.23, P=0.002), and that distribution of the EOT2+1265A>G G* allele-containing genotypes was also much lower in asthmatics (26.3 versus 40.8%, P=0.003). In addition, a non-synonymous SNP in Eotaxin1, EOT1+123Ala>Thr showed significant association with total serum IgE levels (P=0.002-0.02). The effect of EOT1+123Ala>Thr on total serum IgE appeared in a gene-dose-dependent manner. Our findings suggest that the development of asthma may be associated with EOT2+1265A>G polymorphisms, and the susceptibility to high IgE production may be attributed to the EOT1+123Ala>Thr polymorphism. Eotaxin variation/haplotype information identified in this study might provide valuable insights into strategies for the control of asthma.