Biosimilars: concept, current status, and future perspectives in inflammatory bowel diseases

The inflammatory bowel diseases (IBD), which consist of Crohn’s disease and ulcerative colitis, are chronic, incurable immunemediated inflammatory disorders of the intestine. As IBD incidence continues to increase globally and its mortality is low, prevalent cases of IBD are rapidly increasing, thereby leading to a substantial increase in health care costs. Although the introduction of biologic agents for IBD management has revolutionized the armamentarium of IBD therapy, the high cost of this therapy is concerning. With the expirations of patents for existing biologic agents (originals), biosimilars with cheaper costs have been highlighted in the field of IBD. Despite concerns regarding their short- and long-term efficacy, safety, immunogenicity, and interchangeability, increasing evidence via prospective observations and phase III or IV clinical trials, which aim to prove the “biosimilarity” of biosimilars to originals, has partly confirmed their efficacy, safety, and interchangeability. Additionally, although patients and physicians are reluctant to use biosimilars, a positive budget impact has been reported owing to their use in different countries. In the near future, multiple biosimilars with lower costs, and efficacy and safety profile similar to originals, could be used to treat IBD; thus, further consideration and knowledge dissemination are warranted in this new era of biosimilars.

The Effects of Bridge Exercise with One Hip Joint Adduction on Trunk Muscle Thickness

Purpose@#This study aimed to verify the effects of bridge exercise with resistance to one hip joint adductor muscle on the thickness of external and internal oblique abdominal muscles, transversus abdominis muscle, and erector spinae muscle. @*Methods@#The subjects were divided into two exercise groups: 15 for Bridge Exercise Group (BEG) and 15 for One Hip joint Adduction Bridge Exercise Group (OHABEG). The study used an ultrasonic instrument to measure trunk muscle thickness. OHABEG performed a bridge exercise with one hip Joint adduction. BEG performed a bridge exercise without resistance. @*Results@#The external oblique abdominal, internal oblique abdominal, and the transversus abdominis muscles showed a significant increase by period and time in intra-group interactions (p0.05). The erector spinae muscle had a significant increase in each period (p0.05). @*Conclusion@#These results demonstrated that bridge exercise with one hip joint adduction had positive effects on trunk muscle thickness. These results confirm that a bridge exercise with one hip joint adduction has a positive effect on the muscle thickness of trunk, suggesting the possibility of using it as a rehabilitation treatment for a lumbar stabilization exercise and as a basic data.

The Effects of Bridge Exercise with One Hip Joint Adduction on Trunk Muscle Thickness

Purpose@#This study aimed to verify the effects of bridge exercise with resistance to one hip joint adductor muscle on the thickness of external and internal oblique abdominal muscles, transversus abdominis muscle, and erector spinae muscle. @*Methods@#The subjects were divided into two exercise groups: 15 for Bridge Exercise Group (BEG) and 15 for One Hip joint Adduction Bridge Exercise Group (OHABEG). The study used an ultrasonic instrument to measure trunk muscle thickness. OHABEG performed a bridge exercise with one hip Joint adduction. BEG performed a bridge exercise without resistance. @*Results@#The external oblique abdominal, internal oblique abdominal, and the transversus abdominis muscles showed a significant increase by period and time in intra-group interactions (p0.05). The erector spinae muscle had a significant increase in each period (p0.05). @*Conclusion@#These results demonstrated that bridge exercise with one hip joint adduction had positive effects on trunk muscle thickness. These results confirm that a bridge exercise with one hip joint adduction has a positive effect on the muscle thickness of trunk, suggesting the possibility of using it as a rehabilitation treatment for a lumbar stabilization exercise and as a basic data.

Effect of Plank Exercise Combined with Breathing and Arm Exercises on Abdominal Muscle Thickness

PURPOSE: This study examined the effects of plank exercise combined with breathing and arm exercises on the external oblique, internal oblique, and transverse abdominal muscle thickness. METHODS: Thirty healthy adults consisting of 12 males and 18 females from K area were divided into a plank exercise combined with breathing and arm exercises group (n = 15) and a plank exercise only group (n=15). The changes in muscle thickness before the exercise and four and eight weeks after the exercise were analyzed using a two-way repeated analysis of variance (ANOVA). The significance level was set to α=0.05. Post-hoc t-tests were conducted to detect the interactions between the time and groups, and the significance level was set to α=0.01. RESULTS: According to the experimental results, the external oblique abdominal muscle showed significant differences over time (p<0.05). The internal oblique abdominal muscle also showed significant differences over time and in the interactions between the time and groups (p<0.05). The transverse abdominal muscle showed significant differences over time, in the interactions between time and groups, and in the changes between the groups (p<0.05). CONCLUSION: The results indicated that plank exercise combined with breathing and arm movement exercises led to increases in the abdominal muscle thickness. These types of exercises may be useful in lumbar stabilization rehabilitation treatment.

The Effect of Kinesio Taping Pre-intervention on Delayed Onset Muscle Soreness

PURPOSE: This examined the effect of Kinesio taping pre-intervention on the pain, tenderness, proprioceptive sensation, and muscle strength associated with delayed onset muscle soreness. METHODS: Thirty subjects were divided into a Kinesio taping application group of 15 subjects and a control non-taped group of 15 subjects, and the changes in individual variables were analyzed before taping and at 24, 48, and 72 hours after taping using two-way repeated ANOVA. Post-hoc t-tests were conducted in the cases with intergroup interactions, and the significance level α was set to α=0.01. RESULTS: The changes in pain during rest were significantly different only for the times, while the changes in pain during exercise were significantly different for the times, interactions between the times and groups, and intergroup changes (p<0.05). The changes in tenderness were significantly different for the times and for interactions between the times and groups (p<0.05). The changes in proprioceptive sensation were significantly different for the times, interactions between times and groups, and intergroup changes (p<0.05). The changes in muscle strength were significantly different only for the times (p<0.05). CONCLUSION: The application of Kinesio taping had positive effects on the pain, tenderness, and proprioceptive sensation of delayed onset muscle soreness. These results suggest that Kinesio taping can be a useful therapeutic factor in future studies and in clinical settings.

Autoimmune Pancreatitis Featuring a Pseudocyst Requiring Drainage despite Steroid Therapy / 대한내과학회지

Autoimmune pancreatitis (AIP) is rarely associated with pancreatic pseudocysts. AIP-associated pseudocysts requiring drainage despite steroid therapy are rather rare. We report a case of AIP with an infected pseudocyst requiring drainage despite steroid therapy. A 68-year-old male was diagnosed with AIP via pancreatic imaging, a high serum immunoglobulin G4 level, and steroid responsiveness. The AIP was accompanied by a pancreatic pseudocyst. Steroid therapy was prescribed, but the pancreatic pseudocyst became aggravated during steroid tapering. Endoscopic ultrasonography-guided cyst drainage was required; the pseudocyst then became completely resolved.

Effects of Knee Extension Exercise Using Blood Flow Restriction on the Thickness and Balance Ability of Tendons

PURPOSE: This study examined the effects of knee extension exercise using blood flow restriction on the changes in the thickness and static balance ability of the tendon of the rectus femoris muscle and achilles tendon. METHODS: A total of 30 subjects was were divided into two groups of 15 subjects each. The changes in the thickness and balance of their tendons were measured by ultrasonography and balance equipment. The measurements were taken three times: before the experiment, 4 weeks after, and 8 weeks after. The results were analyzed by repeated measure ANOVA, one-way ANOVA was conducted in cases where there were time-to-group interactions in the intra-individual effects test. RESULTS: Significant differences in the thickness of the tendon of the rectus femoris muscle and Achilles tendon were found between the groups, over time, and in the time-to-group interactions (p 0.05). CONCLUSION: Knee extension exercise using blood flow restriction leads to significant differences in the increase in tendon thickness and changes in balance, indicating that the results of this study can be utilized as basic data for future studies and for rehabilitation treatment at clinics.

The Impact of Vibration Exercises on Shoulder Muscle Thickness

PURPOSE: The objective of this study was to examine the effect of vibration exercises generated from an XCO® trainer on supraspinatus, infraspinatus, teres minor, and deltoid muscle thickness. METHODS: Thirty subjects were evenly divided into two groups. Muscle thickness was measured by a sonogram prior to the study, and at three and six weeks after the intervention. Changes in muscle thickness were analyzed using a repeated measure analysis of variance (ANOVA). The significance level for the statistical test was set at α=0.05. RESULTS: A statistically significant differences in timing, interactions between timing and the groups, and between-group changes were demonstrated for supraspinatus muscle thickness (p 0.05). CONCLUSION: Significant changes were observed in the thickness of the supraspinatus, infraspinatus, teres minor, and deltoid muscles, owing to the use of vibration exercises generated from an XCO® trainer. These findings can be used as a foundation for future studies on rehabilitation training.

Removal of Pancreatic Duct Stones by Endoscopic Ultrasonography-Guided Rendezvous ERCP / 대한내과학회지

Symptomatic pancreatic ductal stones can be removed nonsurgically by endoscopic retrograde cholangiopancreatography (ERCP), either alone or in combination with extracorporeal shock-wave lithotripsy (ESWL). Here, we report a case of successful endoscopic ultrasonography (EUS)-guided rendezvous ERCP for removal of radiolucent pancreatic stones after failed ERCP and ESWL. A 79-year-old male with painful chronic pancreatitis associated with pancreatic stones and a dilated upstream duct underwent transgastric antegrade pancreatography via EUS-guided pancreatic duct access followed by rendezvous ERCP. In this patient, EUS-guided rendezvous ERCP was successful in salvaging pancreatic duct cannulation after unsuccessful ERCP due to a tight stricture at the pancreatic duct orifice and removing radiolucent pancreatic stones after ESWL, which was unsuccessful because of failure to localize the stones due to their radiolucency under x-ray fluoroscopy.

Comparing Intelligence Test Profiles to Assess Tourette's Disorder with Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The study compared the intelligence test profiles of Tourette's Disorder (TD), attention-deficit hyperactivity disorder (ADHD), and TD with ADHD (TD+ADHD) groups. METHODS: The Korean Wechsler Intelligence Scale for Children-third edition (K-WISC-III) and Korean Wechsler Intelligence Scale for Children-fourth edition (K-WISC-IV) were administered to 13 children and adolescents with TD, 17 children and adolescents with ADHD, and 15 children and adolescents with TD+ADHD. Each parameter was compared among the groups using the Kruskal-Wallis test. RESULTS: The mean scores of the freedom from distractibility/working memory index (FD/WMI) and the digit span and arithmetic subtests of the TD+ADHD group were significantly lower than those of the TD group. CONCLUSION: According to the intelligence test results, the comorbid ADHD+TD group showed a significant decrease in working memory compared to the TD group. These findings are similar to those of previous research on cognitive functions and suggest that the TD+ADHD comorbid and TD alone groups exhibit different endophenotypes. The results also imply that WISC-III and WISC-IV, the most commonly used intelligence tests clinically, are effective in evaluating cognitive functions such as attention. Further research is required to confirm these results.

Effects of Blood Flow Restriction and Different Support Surfaces on the Thickness of Type-I Muscle Fibers in the Trunk

PURPOSE: This study was conducted to investigate the effects of blood flow restriction and different support surfaces for bridge exercises on the thickness of the transverse abdominis and multifidus, which are trunk-stabilizing muscles. METHODS: The study's subjects were 45 adults who were divided into three groups that performed bridge exercises over a six-week period on their respective support surfaces after blood flow restriction. Changes in the thickness of the subjects' transverse abdominis and multifidus muscles were measured using ultrasonography before the experiment, then three and six weeks after the experiment. The changes in each variable over time were analyzed using a repeated-measures analysis of variance (ANOVA). RESULTS: The transverse abdominis showed significant differences in muscle thickness with regard to time and the interaction between time and each group (p0.05). The multifidus showed significant differences in muscle thickness with regard to time, the interaction between time and each group, and changes between groups (p<0.05). CONCLUSION: Blood flow restriction and different support surfaces for bridge exercises led to significant differences in the thickness of the transverse abdominis and multifidus. This study's results may be used as the basis for future studies and for rehabilitation in clinical practice.

Effects of Different Sizes of Blood Flow Restriction Areas on Changes in Muscle Thickness

PURPOSE: This study was conducted to examine the effects of different sizes of blood flow restriction areas on the thickness of the external oblique and biceps brachii. METHODS: The study subjects were 52 adults who were divided into four groups that performed plank exercises over a six-week period after blood flow restriction. Changes in the thickness of the external oblique and biceps brachii were measured using ultrasonography before the experiment, then three and six weeks after the experiment. The changes in each variable over time were evaluated by repeated-measures analysis of variance (ANOVA). RESULTS: The external oblique and biceps brachii showed significant differences in muscle thickness with regard to time and the interaction between time and each group (p0.05). CONCLUSION: A larger blood flow restriction area resulted in a statistically significant increase in muscle thickness. The results of this study may be used as the basis for future studies and for rehabilitation in clinical practice.

IgG4-Related Sclerosing Cholangitis Showing Natural Course of Progression to Decompensated Liver Cirrhosis / 대한췌담도학회지

Immunoglobulin G4-related disease (IgG4-RD) is characterized by extensive IgG4-positive plasma cells infiltration resulting in inflammation and fibrosis of the affected organs. Patient with IgG4-RD shows an excellent response to glucocorticoid therapy especially when given at early onset stages. IgG4-related sclerosing cholangitis (IgG4-SC) is considered biliary manifestation of IgG4-RD. The natural history and long-term prognosis of IgG4-SC is not well defined and most of the previous case series have reported short duration of follow-up. We present the case of development of decompensated liver cirrhosis from IgG4-related sclerosing cholangitis with a 6-year natural clinical course.

Ulnar Shortening Osteotomy for the Treatment of Ulnar Impaction Syndrome

PURPOSE: To compare the clinical outcomes of the ulnar shortening osteotomy alone and the ulnar shortening osteotomy with arthroscopic debridement in the idiopathic ulnar impaction syndrome with positive ulnar variance. MATERIALS AND METHODS: Twenty seven cases, who underwent the ulnar shortening osteotomy with or without arthroscopic debridement for treatment of the idiopathic ulnar impaction syndrome with positive ulnar variance, were included. The mean age was 40.3 years (range, 21 to 63 years) and the mean follow-up period was 20.6 months (range, 12 to 60 months). The ulnar shortening osteotomy alone and the ulnar shortening osteotomy with arthroscopic debridement were performed in 14 and 13 cases respectively. Pre- and postoperative functional results of the wrist were evaluated by the modified Mayo wrist score. RESULTS: The ulnar variance was corrected from 4.61 mm (range, 1.8~10 mm) to -0.06 mm (range, -3.3~3.1 mm) in the ulnar shortening osteotomy alone group and from 3.01 mm (range, 1.2~7.6 mm) to -0.74 mm (range, -1.8~0 mm) in the ulnar shortening osteotomy with arthroscopic debridement group. The final results of the ulnar shortening osteotomy alone were excellent in 4 cases, good in 5 cases, and fair in 5 cases. Those of the ulnar shortening osteotomy with arthroscopic debridement group were excellent in 6 cases, good in 2 cases, fair in 1 case, and poor in 2 cases. The modified Mayo wrist score at the last follow-up were 83.57(range, 75~100) in the ulnar shortening osteotomy alone group and 83.35(range, 40~100) in the ulnar shortening osteotomy with arthroscopic debirdement group. No statistically significant difference was demonstrated between two groups (p=0.43). CONCLUSION: The ulnar shortening osteotomy is valuable treatment for the idiopathic ulnar impaction syndrome with positive ulnar variance. The combined arthroscopic debridment does not appear to have positive influence to the final results.

Scaphoid-capitate-hamate-triquetrum Fusion in the Advanced Kienbock's Disease

PURPOSE: To evaluate clinical and radiological results of SCHT(scapho-capito-hamato-triquetral) fusion in Lichtman stage IIIB or IV Kienbock's disease. MATERIALS AND METHODS: The result of eight cases, operated and followed since December 2002, were analyzed retrospectively. The indication of SCHT fusion was the advanced Kienbock's disease, in Lichtman stage IIIB or IV, with severe fragmentation of lunate. The fragmented lunate was excised and the intercarpal joint between scaphoid and capitate, capitate and hamate, hamate and triquetrum were fused with joint resection, bone graft and multiple K-wires, to make an horse-shoeshaped carpal bone block. The clinical results were evaluated by wrist pain, ROM, any radiologic changes of wrist at last follow-up and Kuschner's method. RESULTS: There were 3 cases of Stage IIIB and 5 cases of stage IV. Mean follow-up period was 28.9 (range 15-53) months, and mean age at the time of operation was 49.4 (range 33~66) years. Two cases were minus ulnar variance, 4 cases were positive and 2 cases were neutral. The wrist range of motion was decreased from 121.8degreesto 90.6degrees(25%). Carpal height ratio was decreased in 1 case. The last follow-up results according to Kuschner's method revealed 4 excellent, 3 good and 1 fair. CONCLUSIONS: SCHT fustion was considered as one of the favorable salvage procedure for the advanced Kienbock's disease. However, biomechanical study using cadaver, long-term follow-up & accumulation of more cases would be needed to confirm its definitive usefulness in the future.

A Case of Moyamoya Disease with Severe Preeclampsia / 대한주산의학회잡지

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

A Case of Moyamoya Disease with Severe Preeclampsia / 대한주산의학회잡지

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

Three Cases of Separation of Symphysis Pubis During Vaginal Delivery / 대한주산의학회잡지

Separation of symphysis pubis during vaginal delivery is rare condition with incidence ranging from 1/500 to 1/30000 deliveries. The injury is caused by fetal head exerting pressure on pelvic ligaments that have been relaxed by progesterone and relaxin. The separation might be associated with considerable pain, swelling and tenderness over the pubic area. Diagnosis is based on clinical findings and X-ray findings. The condition is treated conservatively with bed rest, analgesics and physical therapy. Prognosis is exellent. We experienced 3cases of separation of symphysis pubis during vaginal delivery and report these cases with a brief review of literature.

Arthroscopic Treatment of Tibia Intercondylar Eminence Comminuted Fracture Used Number 5-nonabsobable Suture Material

PURPOSE: To evaluate effect of modified arthroscopic pull-out suture technique which used number 5-nonabsorbable suture material for tibia intercondylar eminence comminuted fractures. MATERIALS AND METHODS: There were 21 cases of tibia intercondylar emimence fracture which arthroscopic treated at our hospital between 1999 and 2004. However the study population only included 12 cases in which a number 5-nonabsorbable suture material (Ethibond No. 5) was used for tibia intercondylar eminence comminuted fractures and minimum 1-year follow-up has gone. The average follow-up period was 18.5 months (range, 12 to 42 months). Lachman test and KT-2000 athrometer test were evaluated at the pre-and post-operation. Clinical results of all patients were evaluated with the Meyers and Mckeever 's criteria. RESULTS: In all 12 cases, the normal range of motion and sports activities were recovered at the final follow-up. When tested for anterior instability with KT-2000 arthrometer, there were no different between normal knee and operated knee. Clinical results by Meyers and Mckeever's criteria were excellent in 10 patients and good in 2 patients. CONCLUSION: We obtained early mobilization and stable fixation in modified arthroscopic pullout suture technique for tibia intercondylar eminence comminuted fractures. Patients can early return to his job. This technique seems to be one of the effective operative techniques for treatment of tibia intercondylar eminence comminuted fractures.

Cervical pregnancy and therapeutic options / 대한산부인과학회잡지

Of all forms of ectopic gestation, the possibility of fertility catastrophe is highest with a cervical pregnancy. Though rare, it is a potentially life-threatening condition. In the past it was diagnosed late, after there was profuse hemorrhage from the cervix and it usually required hysterectomy. With ultrasound, diagnosis can be made earlier and conservative management attempted in order to preserve the reproductive potential. Methotrexate has been used both systemically and intra-amniotically to treat cervical ectopic gestation conservatively.