The Gut-Heart Axis: Updated Review for The Roles of Microbiome in Cardiovascular Health

Cardiovascular diseases (CVDs), including coronary artery disease, stroke, heart failure, and hypertension, are the global leading causes of death, accounting for more than 30% of deaths worldwide. Although the risk factors of CVDs have been well understood and various treatment and preventive measures have been established, the mortality rate and the financial burden of CVDs are expected to grow exponentially over time due to the changes in lifestyles and increasing life expectancies of the present generation. Recent advancements in metagenomics and metabolomics analysis have identified gut microbiome and its associated metabolites as potential risk factors for CVDs, suggesting the possibility of developing more effective novel therapeutic strategies against CVD. In addition, increasing evidence has demonstrated the alterations in the ratio of Firmicutes to Bacteroidetes and the imbalance of microbial-dependent metabolites, including short-chain fatty acids and trimethylamine N-oxide, play a crucial role in the pathogenesis of CVD. However, the exact mechanism of action remains undefined to this day. In this review, we focus on the compositional changes in the gut microbiome and its related metabolites in various CVDs. Moreover, the potential treatment and preventive strategies targeting the gut microbiome and its metabolites are discussed.

Open Surgical Repair Using the Femoral Vein for a Mycotic Superior Mesenteric Artery Aneurysm

Superior mesenteric artery (SMA) aneurysms are rare and often fatal. A 72-year-old man had previously been admitted to the emergency room with epigastric pain and heart murmur. The echocardiographic diagnosis was vegetation on the aortic and mitral valves, with moderate regurgitation from both valves due to infective endocarditis. No aneurysm was detected on abdominal computed tomography, and emergency double-valve replacement was performed. On postoperative day 25, the patient experienced abrupt abdominal pain, and computed tomography revealed a mycotic SMA aneurysm. Open surgical repair of the SMA aneurysm was performed using the femoral vein, and the patient's postoperative course was uneventful.

Right Main Bronchus Rupture Presenting with Pneumoperitoneum

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.

Extracorporeal Life Support in Patients with Hematologic Malignancies: A Single Center Experience

BACKGROUND: Extracorporeal life support (ECLS) in patients with hematologic malignancies is considered to have a poor prognosis. However, to date, there is only one case series reported in the literature. In this study, we compared the in-hospital survival of ECLS in patients with and without hematologic malignancies. METHODS: We reviewed a total of 66 patients who underwent ECLS for treatment of acute respiratory failure from January 2012 to December 2014. Of these patients, 22 (32%) were diagnosed with hematologic malignancies, and 13 (59%) underwent stem cell transplantation before ECLS. RESULTS: The in-hospital survival rate of patients with hematologic malignancies was 5% (1/22), while that of patients without malignancies was 26% (12/46). The number of platelet transfusions was significantly higher in patients with hematologic malignancies (9.69±7.55 vs. 3.12±3.42 units/day). Multivariate analysis showed that the presence of hematologic malignancies was a significant negative predictor of survival to discharge (odds ratio, 0.07; 95% confidence interval, 0.01–0.79); p=0.031). CONCLUSION: ECLS in patients with hematologic malignancies had a lower in-hospital survival rate, compared to patients without hematologic malignancies.

Tricuspid Papillary Fibroelastoma Mimicking Tricuspid Vegetation in a Patient with Severe Neutropenia

We report a 72-year-old male with known myelodysplastic syndrome who presented to the emergency department with a 7-day history of fever and dyspnea. Echocardiography revealed a round echogenic mass 13×16 mm in size attached to the atrial side of the tricuspid valve. Considering the high risk of infective endocarditis in the patient with a low absolute neutrophil count (130/mm3), emergency surgery was performed. Intraoperatively, a single gelatinous neoplasm was resected, and subsequent reconstruction of the involved leaflet was accomplished using autologous pericardium. The tumor was pathologically confirmed as papillary fibroelastoma with no evidence of infective endocarditis. Papillary fibroelastoma is a rare cardiac neoplasm that occurs in either the mitral or aortic valves. Interestingly, a few cases of tricuspid valve papillary fibroelastoma have been reported so far. Similar echocardiographic findings between vegetation and tricuspid valve neoplasm make it difficult to distinguish these two disease entities.

Quality of Life in Melasma / 대한피부과학회지

BACKGROUND: Melasma is a common pigmentary disorder of facial skin. It can have significant emotional, social, and psychological effects. But little is known about the impact of melasma on the quality of life (QOL) in Korean patients. OBJECTIVE: The purpose of this study was to investigate the quality of life in patients with melasma. METHODS: A total of 100 patients with melasma were enrolled and interviewed against the Melasma Quality of Life scale (MELASQOL), which was recently developed by Balkrishnan et al. The patients were also evaluated by the investigator using the Melasma Area and Severity Index (MASI). RESULTS: The average score of MELASQOL was 41.2. A high score meant that melasma had a great effect on quality of life. It was high in patients with high MASI scores (p<0.01), young patients (p<0.01), and short duration of melasma (p<0.05). It was also high in those who had a high education level (p<0.05), or a previous treatment history (p<0.01). However, presence or absence of other skin diseases or preceding causes made no significant difference. CONCLUSION: This study shows that melasma has significant impact on the QOL of Korean melasma patients. Therefore, in addition to treating melasma, clinicians need to consider the psychosocial aspects of improving QOL in order to give patients optimal satisfaction.

Analysis of the Monocyte Chemoattractant Protein 1 -2518 Promoter Polymorphism in Korean Patients with Alopecia Areata

Monocyte chemoattractant protein-1 (MCP-1) levels are increased in scalp lesions of patients with alopecia areata (AA), suggesting a role in the development of AA. Recently, a biallelic A/G polymorphism in the MCP-1 promoter at position -2518 has been found, influencing the level of MCP-1 expression in response to an inflammatory stimulus. We investigated whether the presence of these polymorphisms were associated with AA in Korean population. 145 Korean patients with AA, 246 healthy subjects without clinical evidence of AA were screened for genotype with a PCR-based assay. In the AA patients the frequency of the A and G alleles was 40.3 and 59.7%, respectively and the distribution of the A/A, A/G and G/G genotypes was 19.3, 42.1 and 38.6%, respectively. Amongst the controls the frequency of the A and G alleles was 39.8 and 60.2%, and the distribution of the A/A, A/G, G/G genotypes in the same group was 17.5, 44.7 and 37.8%, respectively. There was no significant difference in the allele frequencies and genotype distributions between the patients and the controls (p=0.889, p=0.848, respectively). Our data indicates that no association exists between the -2518A/G polymorphism of the MCP-1 gene and susceptibility to alopecia areata.

Herpes Zoster of the Penis / 대한비뇨기과학회지

Although herpes zoster can affect any dermatome, outbreaks most often occur in the thoracic and facial regions. Recently, herpes zoster involving the penis was reported. Here, an unusual case of herpes zoster involving the penis, with underlying prostate cancer, is reported.

A case of Non-Traumatic Myositis Ossificans in Quadriceps Femoris / 대한피부과학회지

Myositis ossificans is a rare benign ossifying lesion in skeletal muscles which is commonly seen after trauma. However, it has been reported that myositis ossificans can be developed without any history of trauma and surgery. A 37-year-old female presented with a painful progressive swelling in her right femoral area, with no history of trauma or other diseases, which had been developed for 2 weeks. Initial X-rays were normal. An incision biospy specimen showed a lesion of fibroblastic tissue in which areas of osteoid and trabecular bone tissue, which was compatible with the early stage of myositis ossificans. The mass was excised totally and no signs of recurrence have been noted until now.

Short-term Effects of 308-nm Xenon-chloride Excimer Laser and Narrow-band Ultraviolet B in the Treatment of Vitiligo: A Comparative Study

We compared the clinical efficacy of a short-term intervention of 308-nm excimer laser with that of narrow-band UVB (NBUVB) phototherapy for vitiligo patients to see the early response. Twenty-three symmetrically patterned patches of vitiligo on 8 patients were selected. Vitiligo patches on one side of the body were treated 2 times per week for a maximum of 20 treatments with the excimer laser, and NBUVB phototherapy was used on patches on the other side. Improvement (repigmentation) was assessed on a visual scale via serial photographs taken every five treatments and scored as follows: 0, or=75% improvement. At five treatments, the excimer laser-treated patches had an average score of 0.26, compared with 0.04 for patches treated with NBUVB phototherapy. A slightly higher repigmentation (p>0.05) in the excimer treated area was thus observed. At 10, 15, or 20 treatments, the differences between the average scores were significant: 0.83, 1.17, and 1.39 for the excimer-treated patches, and 0.17, 0.30, and 0.74 for the NBUVB pho-totherapy-treated areas (p<0.05). In conclusion, the 308-nm excimer laser appears to be more effective than NBUVB phototherapy, as it produces more rapid and profound repigmentation.

A Case of Bullous Pilomatricoma / 대한피부과학회지

A 24-year old man with no history of trauma or other diseases presented with a tender growing lesion on the left upper arm for ten months' duration. The clinical appearance was similar to that of bulla. An excisional biopsy revealed multiple islands of shadow cells with small foci of basophilic cells at the periphery in deep dermis, along with areas of calcification and foreign body reaction within the tumor. In the dermis above the tumor, was collagen degeneration, with large spaces and numerous dilated blood vessels.

Differential Expression of TGF-beta Isoforms During Differentiation of HaCaT Human Keratinocyte Cells: Implication for the Separate Role in Epidermal Differentiation

The three mammalian isoforms of transforming growth factor-beta (TGF-beta1, beta2, beta3) are potent regulators of cell growth, differentiation, and extracellular matrix deposition. To study their role in skin differentiation, we investigated the expression of TGF-beta isoforms on cell growth and differentiation induction of the human keratinocyte cell line, HaCaT by elevating the Ca2+ concentration. An ELISA and RT-PCR assay revealed secreted TGF-beta 1 protein and TGF-beta1 mRNA were increased during calci-um-induced differentiation. In contrast, major differences were seen for TGF-beta 2 and TGF-beta 3 mRNA which were decreased during differentiation, but TGF-beta 2 and TGF-3beta protein were not evident on an ELISA. These results suggest different functions for each TGF-beta isoforms in epidermal differentiation, such that TGF-beta 1 is associ-ated with the more differentiated state, and TGF-beta 2 and TGF-beta 3 may be associ-ated the more proliferated state.

Acquired Perforating Dermatosis in Patients with Chronic Renal Failure and Diabetes Mellitus

Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. The purpose of this study was to clarify the clinical and histopathological features of APD, and evaluate role of scratching in the pathogenesis of APD. Twelves patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.

Induction of IL-lα mRNA Expression by 17β-Estradiol in Normal Human Keratinocytes

No abstract available.

Two Cases of Solitary Adult Myofibroma

No abstract available.

A Case of Pyoderma Gangrenosum Associated with Autoimmune Chronic Active Hepatitis / 대한피부과학회지

Pyoderma gangrenosum (PG) is an inflammatory ulcerative condition of unclear etiology. In more than 50% of cases, lesions occur in association with an underlying systemic disorder-most notably; inflammatory bowel disease (IBD), rheumatoid arthritis, or a hematologic abnormality. Here, we report a rare case of pyoderma gangrenosum associated with autoimmune chronic active hepatitis. A 34-year-old woman presented with a 2-month history of a painful ulceration on her back. She was clinically diagnosed as having pyoderma gangrenosum and an appropriate exclusion was performed. She had abnormal results for liver biochemical tests, with a hepatitis-like picture and high titer of antinuclear antibodies. According to the scoring system proposed by the International Autoimmune Hepatitis Group she had `definite' autoimmune hepatitis and responded well to immunesuppressive treatment.