Hepatic Expression of the Serine Palmitoyltransferase Subunit Sptlc2 Reduces Lipid Droplets in the Liver by Activating VLDL Secretion

Objective@#Ceramide is a signaling molecule that contributes to insulin resistance and hepatosteatosis. In the present study, we activated de novo ceramide synthesis by inducing the hepatic expression of Sptlc2 to investigate the role of ceramide in glucose and lipid metabolism. @*Methods@#We first constructed an adenovirus containing Sptlc2 (AdSptlc2), which encodes a major catalytic subunit of serine palmitoyltransferase (SPT). We then infected hepatocytes and mice fed a regular diet with AdSptlc2 to activate de novo ceramide biosynthesis. The liver-specific effects of ceramide biosynthesis on glucose and lipid metabolism were investigated by measuring changes in insulin signaling, lipid droplet formation, and very low-density lipoprotein (VLDL) secretion. @*Results@#In HepG2 hepatocytes, adenoviral Sptlc2 expression inhibited insulin signaling and increased ceramide levels via activation of c-Jun N-terminal kinase and serine phosphorylation of insulin receptor substrate 1. In contrast, in mice, AdSptlc2 infection decreased plasma glucose levels by downregulating gluconeogenic genes and increased plasma triglyceride levels by increasing VLDL secretion. In mice infected with AdSptlc2, glucose intolerance and insulin sensitivity improved, while pyruvate utilization via gluconeogenesis decreased. @*Conclusion@#Hepatic ceramide was found to modulate hepatosteatosis and the insulin response via increased VLDL secretion and inhibition of gluconeogenesis in vivo. Although inhibition of the insulin response was observed in vitro, the compensatory mechanism of relieving ceramide-induced stress and reducing ceramide levels resulted in improvements of glucose and lipid metabolic profiles in vivo. This discrepancy between in vitro and in vivo regulation mechanisms suggests that ceramide plays a role in non-alcoholic fatty liver disease and insulin resistance.

Emergency room visits for severe complications after cosmetic surgery

BACKGROUND: Because many cosmetic surgery clinics are not adequately equipped to handle emergent conditions, patients often come to a university hospital when problems occur during or after cosmetic surgery. However, few in-depth studies have been conducted of this issue. Therefore, we investigated emergency department visits due to complications associated with cosmetic surgery. METHODS: A retrospective chart review was conducted of 38 patients who visited the emergency department of the authors' institution due to complications associated with cosmetic surgery from July 2014 to June 2017. RESULTS: There were more women than men (30 women vs. 8 men). Their mean age was 32.4 years (range, 19–57 years). Upon presentation to the emergency department, patients' vital signs and mental status were usually normal (27 normal vs. 11 abnormal). The types of surgery included blepharoplasty, rhinoplasty, malar/orthognathic surgery, mammaplasty, liposuction, fat grafting, and filler and botulinum toxin injections. Most patients required hospitalization (26 admitted vs. 12 discharged). Eight of the hospitalized patients required intensive care unit care, of whom two died and three experienced brain death or had permanent neurologic sequelae. CONCLUSIONS: The complications were usually minor problems, despite the need for hospitalization, but some complications were life-threatening. We recommend close monitoring and maintaining an adequate injection capacity for intravenous sedative anesthesia. When any symptom or sign of a complication occurs, it is best to transfer the patient to a university hospital as soon as possible. Taking a careful medical history is always needed, even for minor procedures.

Endoscopic transaxillary prepectoral conversion for submuscular breast implants

BACKGROUND: During breast augmentation, the transaxillary approach provides the advantage of allowing the mammary prosthesis to be placed through incisions that are remote from the breast itself, thereby reducing the visibility of postoperative scars. For patients experiencing capsular contracture who do not want additional scars, the previous transaxillary scar can be used for site change and implant exchange. METHODS: This study analyzed 17 patients (34 breasts) with submuscular breast implants with grade III-IV capsular contracture who received treatment from 2010 to 2015. The mean age of the patients was 29 years (range, 20–38 years). The inclusion criterion was a pinch test of more than 3 cm at the upper pole of the breast. Previous axillary scars were used to expose the pectoralis fascia, and submuscular breast implants were removed carefully. The dissection underneath the pectoralis fascia was performed with endoscopic assistance, using electrocautery under direct visualization. RESULTS: The mean follow-up period was 14 months (range, 6–24 months). The entire dissection plane was changed from the submuscular plane to the subfascial plane. Round textured gel implants were used, with a mean implant size of 220 mL (range, 160–300 mL). Two patients developed grade II capsular contracture. There were no cases of malposition or asymmetry. Three patients complained of minor implant palpability. None of the patients required additional surgery. CONCLUSIONS: Endoscopic subfascial conversion may be an effective technique for treating capsular contracture and avoiding scarring of the breast in selected patients.

Idiopathic Unilateral Gynecomastia in an Adolescent Male: A Case Report

Gynecomastia refers to persistent enlargement of the breast in males caused by enlargement of the breast bud and surrounding stroma. It typically occurs in newborns, during early adolescence, and in late adulthood. There are several pathological causes. If no pathological cause is evident, gynecomastia is considered idiopathic. The reported prevalence of unilateral gynecomastia is approximately 35% to 45%, but most previous reports have focused on distinctive pathologic causes. As such, few previous reports of idiopathic unilateral gynecomastia during early adolescence have been published. Herein, we report a case of idiopathic unilateral gynecomastia in an adolescent male.

Late Capsular Hematoma after Prosthesis Removal Following Aesthetic Breast Augmentation: A Case Report

Late capsular hematoma formation after augmentation mammoplasty with an implant is a very rare complication. Some mechanisms explaining late capsular hematoma formation have been reported; it is thought to be associated with capsular contracture, textured implants, and the use of corticosteroid and anticoagulant agents. However, no reports of late capsular hematoma formation after prosthesis removal have been published. Herein, we report a case of late capsular hematoma formation after the removal of a prosthesis 10 years previously, following augmentation mammoplasty.

Idiopathic Unilateral Gynecomastia in an Adolescent Male: A Case Report

Gynecomastia refers to persistent enlargement of the breast in males caused by enlargement of the breast bud and surrounding stroma. It typically occurs in newborns, during early adolescence, and in late adulthood. There are several pathological causes. If no pathological cause is evident, gynecomastia is considered idiopathic. The reported prevalence of unilateral gynecomastia is approximately 35% to 45%, but most previous reports have focused on distinctive pathologic causes. As such, few previous reports of idiopathic unilateral gynecomastia during early adolescence have been published. Herein, we report a case of idiopathic unilateral gynecomastia in an adolescent male.

Late Capsular Hematoma after Prosthesis Removal Following Aesthetic Breast Augmentation: A Case Report

Late capsular hematoma formation after augmentation mammoplasty with an implant is a very rare complication. Some mechanisms explaining late capsular hematoma formation have been reported; it is thought to be associated with capsular contracture, textured implants, and the use of corticosteroid and anticoagulant agents. However, no reports of late capsular hematoma formation after prosthesis removal have been published. Herein, we report a case of late capsular hematoma formation after the removal of a prosthesis 10 years previously, following augmentation mammoplasty.

A Meta-Analysis of the Correlates of Resilience in Korean Nurses / 임상간호연구

PURPOSE: Nurses' resilience plays an important role in overcoming the challenges that nurses often encounter at clinic, and many factors have been examined which influence on nurses' resilience levels. Through this study, those factors were systematically searched and quantitatively synthesized. METHODS: In order to find relevant studies, both English and Korean academic databases were searched, and, finally, a total of 33 articles were identified and included in this analysis. RESULTS: The effect size on the protective variables was large and that of the risk variables was medium. In the protective variable group, the job variable group showed a larger effect size compared to the organizational variable group. Among the protective variables, compassion satisfaction showed the highest contribution on enhancing the resilience level of nurses. In the risk variable group, the personal variable group showed the highest effect size, which was followed by the organizational and job variables. Among the risk variables, the personal stress response showed the highest contribution to decreasing the level of resilience of nurses. CONCLUSION: This study provides a meaningful data for future studies in terms of developing evidence-based interventions to enhance the levels of resilience among Korean nurses.

Septoplasty Through Dorsal Approach

Septal deviations interfere with the nasal airflow and contribute to the deformities in the external appearance of the nose. An aesthetically and functionally satisfactory correction of severe septal deformities often requires temporary intraoperative removal of the septal cartilage for appropriate remodeling. This article describes septoplasty through dorsal approach for the correction of septal deviation. From March 2001 to April 2004, the author performed septoplasty through dorsal approach for the correction of septal deviations on 45 patients, of whom 22 of whom had nasal obstruction. Open rhinoplasty was used for dorsal approach in all patients and operation was performed under the general anesthesia or local anesthesia. The follow-up period of the patients ranged from 3 to 15 months with a mean of 10 months, and postoperative results were quite satisfactory. There was neither incidences of patients' complaints, nor any complications such as hematoma, septal perforation, supratip deformity, or recurrence. And there was some improvement of nasal obstruction in 15 patients. In conclusion, Septoplasty through dorsal approach is an effective method for the correction of septal deviation and improvement of the nasal airway obstruction.

The Correction of Inverted Nipple by Modified Elsahy and Broadbent-Woolf Methods

An inverted nipple may have both functional and aesthetic problems such as loss of lactability and hygiene. The inverted nipple may be congenital or caused by trauma, mastitis, mammmoplasy and breast cancer. Many procedures have been described for creating the normal anatomic configuration of the retracted nipple. For correcting the inverted nipple, the authors choose surgical procedure according to the grade of inverted nipple and the need of lactation. A total 37 nipples in 20 patients were operated on from February of 2001 to February of 2005. The patients were classified into 3 grades according to Han and Hong's grading system of inverted nipple. We applied modified Elsahy method to the group of patients in Grade I and patients in Grade II with need of lactation, and we applied Broadbent-Woolf method to the group of patients in Grade III and Grade II with need of lactation. Recurrence was found in 1 case corrected by modified Elshay method and no recurrence was found in those corrected by Broadbent-Woolf method. The patients' satisfaction score was 4.6 points in 5 points perfect score system. We prevented recurrence of inverted nipple with patients' satisfaction by applying different operative procedures according to the grade and patients' need of lactation.

Cystic Fibrosis: Case Report

Cystic fibrosis is a autosomal recessive genetic disease. Among Caucasians, it is the most common cause of pulmonary insufficiency during the first three decades of life. The prevalence of cystic fibrosis varies according to ethnic origin: it is common among Caucasians but rare among Asians. We report a case in which cystic fibrosis with bronchiectasis and hyperaeration was revealed by high-resolution CT, and mutation of the cystic fibrosis conductance transmembrane regulator gene (CFTR) by DNA analysis.

Nasal Tooth: Case Report

Ectopic tooth is not uncommon and usually occurs in the palate and maxillary sinus. We report a case of ectopic tooth located in the nasal cavity, a rare site. The mass depicted by CT was highly attenuated, and central lucency was observed.

Potential Role of Homer-2a on Cutaneous Vascular Anomaly

Homer protein was identified based on its rapid induction in rat hippocampal granule cell neurons following excitatory synaptic activity. Although the presence of the Homer gene in the peripheral tissues has been observed in previous reports, the physiological function of the Homer protein in these tissues has not been noted. In this experiment, a Homer-2a cDNA fragment was successfully amplified by RTPCR in the involuting phase of human hemangioma but not in the human vascular malformation and normal vessel. After isolation of full Homer cDNA in a mouse liver cDNA library, E1-deleted recombinant adenovirus expressing the Homer protein (Adv.CMV.mHomer-2a) was constructed to determine its physiological function in peripheral tissues. Adv.CMV.mHomer2a, but not Adv.CMV.LacZ (recombinant adenovirus expressing beta-galactosidase), strongly inhibited the growth rate of HUVECs (human umbilical vein endothelial cells) probably via inducing apoptosis determined by acridine orange/ethidium bromide (AO/EB) staining methods. This study suggests that the Homer gene is present in human specimens in the involuting phase of hemangioma, and it might be involved in the growth control.

Classification and Operation of Microform Cleft Lip

Microform cleft lip is a mild expression of cleft lip. Downward depression of the nostril rim, skin striae of the upper lip, notching of the Cupid`s bow, and deformity of the vermilion border are characteristic findings. The definition is very important to aid in selection of the operative methods. Based on our operative experiences of cleft lip, we classified microform cleft lip according to our new definition.. According to author`s classification, class I(1 case) has cleft lip nose deformity without lip deformity or with slight short lip of cleft side, class IIa(5 cases) has minimal lip deformity with blurring of cupid`s bow, vermilion notching, and skin striae with intact of orbicularis oris muscle, class IIb(12 cases) has discontinuity of the orbicularis oris muscle, class III(5 cases) has mild lip nose deformity with discontinuity of orbicularis oris muscle including Cupid`s bow deviation. In class IIb and class III, reconstruction of orbicularis oris muscle is important and we repaired it with radical operation by rotation-advancement method. A total of 23 microform cleft lip result was reviewed. We treated the clefts following the above principles according to the classification and obtained satisfactory results.

Clinical Considerations of Gigantic Lipoma

The gigantic lipoma could be categorized into subcutaneous and subfascial type. We experienced eight cases from seven patients. Five cases of them were proved to be subcutaneous gigantic lipomas, and three cases were proved to be subfascial gigantic lipomas. Among the subcutaneous type, three cases of liposarcomas were confirmed by final biopsy results. And three cases of recurrences were shown. Among the subfascial type, one case of chondrolipoma was confirmed by final biopsy result and no recurrence was not found. In brief, subcutaneous and subfascial gigantic lipoma had a specific characteristics as followings: Subcutaneous type showed asymptomatic mass with bulging, multilobulated and poorly marginated. And it was difficult for complete removal with a high recurrence rate. Radical excision and liposuction recommended for its treatment. On the other hand, subfascial type showed diffuse expansion, late onset of symptom. And it was readiness for complete removal with no recurrence after complete excision.

Variable Methods of Protection for the Exposed Facial Nerves after Parotidectomy

Two significant unsolved problems in parotidectomy procedures are Frey's syndrome and postoperative depression deformity. The recent trend in the management of these problems has been the use of the prophylatic procedures performed at the time of parotidectomy to prevent its postoperative symptoms or complaints. We used a tissue barrier between the elevated cheek skin flap and the exposed facial nerve in order to prevent Frey's syndrome and depression deformity on the cheek. We used buccal fat, dermis fat graft or flap, superficial temporal fascia(STF) island flap and skin island or free flap as a tissue barrier. Thirty-nine patients had been operated and reviewed for over 3 years and 23 of them were treated with various kinds of tissue barriers. Frey's syndrome, depression deformity and other complications were reviewed. As a result, there was no permanent facial nerve palsy, Frey's syndrome and dissatisfaction with facial contour excluding minor complications of hematoma, scar and temporary facial palsy compared to the cases without the barrier. We concluded that the buccal fat is easy and simple to perform and it can be the first choice in children and young women. The dermis fat graft or flap is suitable for the old patient who requires pertinent volume. STF island flap is a pliable, wide and well vascularized flap, so it is well fit to cover the wide defect in man or old patient. In malignant or extensive lesions, skin island or free flap is recommendable for the simultaneous reconstruction of skin resurfacing and volume filling after the radical resection including the parotid gland. Various autogenous tissue barriers can be effectively and properly applicable to prevent the serious complications after the parotidectomy depending on the cases.

Variable Methods of Protection for the Exposed Facial Nerves after Parotidectomy

Two significant unsolved problems in parotidectomy procedures are Frey's syndrome and postoperative depression deformity. The recent trend in the management of these problems has been the use of the prophylatic procedures performed at the time of parotidectomy to prevent its postoperative symptoms or complaints. We used a tissue barrier between the elevated cheek skin flap and the exposed facial nerve in order to prevent Frey's syndrome and depression deformity on the cheek. We used buccal fat, dermis fat graft or flap, superficial temporal fascia(STF) island flap and skin island or free flap as a tissue barrier. Thirty-nine patients had been operated and reviewed for over 3 years and 23 of them were treated with various kinds of tissue barriers. Frey's syndrome, depression deformity and other complications were reviewed. As a result, there was no permanent facial nerve palsy, Frey's syndrome and dissatisfaction with facial contour excluding minor complications of hematoma, scar and temporary facial palsy compared to the cases without the barrier. We concluded that the buccal fat is easy and simple to perform and it can be the first choice in children and young women. The dermis fat graft or flap is suitable for the old patient who requires pertinent volume. STF island flap is a pliable, wide and well vascularized flap, so it is well fit to cover the wide defect in man or old patient. In malignant or extensive lesions, skin island or free flap is recommendable for the simultaneous reconstruction of skin resurfacing and volume filling after the radical resection including the parotid gland. Various autogenous tissue barriers can be effectively and properly applicable to prevent the serious complications after the parotidectomy depending on the cases.

Reconstructive Treatment of Subungal Malignant Melanoma Through the Early in Situ Level Diagnosis

Subungal malignant melanoma is a relatively rare disease with reported incidence between 1% to 3% of all melanoma cases in the USA, 10% to 31% in Japan. It is a serious disease with a survival period of 5 years. This poor prognosis is the result of late diagnosis in many of the cases, usually the patient not presenting himself early enough in the course of the disease. However, far more important is the frequent failure of the physician or surgeon to recognize the clinical signs and to perform a biopsy from the correct site, which leads to an accurate diagnosis. Therefore we focused the nail color change of the subungal malignant melanoma to diagnose the disease at the early stage. Five patients who visited our hospital with nail color change into black took the biopsy. This should be done on nail bed and matrix lesions which shows color change into black. A wedge form is taken from the area with maximal clinical concern, including normal tissue at the edge of the lesion. In cases of melanoma in situ (4 cases) diagnosed during the previous biopsy, surgical treatment was done as soon as possible. The melanoma was excised by Mohs technique and the margins were checked by frozen section. If the margins and base of tumor did not have micrometastasis, immediate reconstruction using various flaps was done. In case that micrometastasis was suspicious however, special staining using HMB45 immunostaining was done for confirmation. After a few days for special staining, delayed reconstruction was done. By means of the early diagnosis and Mohs micrographic operation technique, we could excise the tumor completely and preserve the tendon, bone, joint and length of digits.

Percutaneous Vertebroplasty in Osteoporotic Vertebral Body Compression Fracture

PURPOSE: To determine the clinical efficacy of percutaneous vertebroplasty in cases of painful and medically intractable osteoporotic vertebral compression fracture. MATERIALS AND METHODS: Ninety-eight patients (20 men and 78 women; mean age, 69 years) underwent 122 per-cutaneous vertebroplasty procedures for the treatment of osteoporotic vertical compression fracture. For the evaluation of bone mass, bone densitometry was performed in 45 patients, and to assess the recent evolution of the fracture, all 98 underwent MRI. Percutaneous vertebroplasty involves percutaneous transpedicular puncture of the involved vertebrae followed by the injection of a Polymethylmethacrylate(PMMA)-Barium mixture into the vertebral body. To assess leakage of the mixture into the epidural tissue, neural foramina, venous plexus and paravertebral tissue, we then immediately obtained a computerized tomographic (CT) scan, assessing the clinical efficacy of the procedure on the basis of time required for pain relief (defined as more than 60% reduction of initial pain), and time required for ambulation without significant pain. RESULTS: Percutaneous vertebroplasty was successful in all patients. Pain relief was accomplished within 1-5(mean, 1.8) days and early ambulation without significant pain was possible within 2 -15 (mean, 3.3) days. Post-procedural CT scanning revealed leakage of the PMMA-barium mixture into Paravertebral tissue(n=41), the paravertebral venous plexus (n=34) and epidural tissue (n=4). No neural foraminal leakage was identified, and no procedure-related complication requiring surgical treatment occurred. CONCLUSION: Percutaneous vertebroplasty is an effective new interventional procedure for the treatment of osteoporotic vertebral compression fracture. It relieves pain, provides early mobilization, and strengthens involved vertebral bodies.

Clinial Evaluation of the Diabetic Foot Associated with Peripheral Vascular Disease or Renal Failure

In the treatment of this complicated diabetic foot patient, we need an effective treatment principle because the complicated diabetic foot patient needs a longer hospitalization period and suffers from more frequent recurrences. We reviewed 43 diabetic foot patients who were treated in our department during the past 4 years. The 43 patients were divided into 4 groups according to their combined complications. Group A was the simple diabetic foot group(no complication group, n = 17). Group B was the diabetic foot group combined with the extensive cellulitis(n = 9). Group C was the diabetic foot group combined with the peripheral vascular disease(n = 8). Group D was the diabetic foot group combined with the renal failure(n = 9). As a results, wide range of reconstructive methods can be selected in the simple diabetic foot group. In group B, early and wide debridement was important to control the infection and later flap reconstruction was appropriate. In group C, the bypass operation should be desperate before improving the circulation of lower extremities, and therefore we successfully reconstructed the foot with various metohds including plantar V-Y advancement flap, considered as the most useful in our series. In group D, recurrence was more frequent and lower extremity amputations above the ankle level couldn't be avoided in spite of many operations and longer hospitalization. Therefore consideration of early amputaiotn is recommended for the effective treatment of this group.