CXCL12 Neutralizing Antibody Promotes Hair Growth in Androgenic Alopecia and Alopecia Areata.

We had previously investigated the expression and functional role of C-X-C Motif Chemokine Ligand 12 (CXCL12) during the hair cycle progression. CXCL12 was highly expressed in stromal cells such as dermal fibroblasts (DFs) and inhibition of CXCL12 increased hair growth. Therefore, we further investigated whether a CXCL12 neutralizing antibody (αCXCL12) is effective for androgenic alopecia (AGA) and alopecia areata (AA) and studied the underlying molecular mechanism for treating these diseases. In the AGA model, CXCL12 is highly expressed in DFs. Subcutaneous (s.c.) injection of αCXCL12 significantly induced hair growth in AGA mice, and treatment with αCXCL12 attenuated the androgen-induced hair damage in hair organ culture. Androgens increased the secretion of CXCL12 from DFs through the androgen receptor (AR). Secreted CXCL12 from DFs increased the expression of the AR and C-X-C Motif Chemokine Receptor 4 (CXCR4) in dermal papilla cells (DPCs), which induced hair loss in AGA. Likewise, CXCL12 expression is increased in AA mice, while s.c. injection of αCXCL12 significantly inhibited hair loss in AA mice and reduced the number of CD8+, MHC-I+, and MHC-II+ cells in the skin. In addition, injection of αCXCL12 also prevented the onset of AA and reduced the number of CD8+ cells. Interferon-γ (IFNγ) treatment increased the secretion of CXCL12 from DFs through the signal transducer and activator of transcription 3 (STAT3) pathway, and αCXCL12 treatment protected the hair follicle from IFNγ in hair organ culture. Collectively, these results indicate that CXCL12 is involved in the progression of AGA and AA and antibody therapy for CXCL12 is promising for hair loss treatment.

Trigger Wrist with Carpal Tunnel Syndrome Accompanied with Trifid Median Nerve: A Case Report and Literature Review.

Trigger wrist, characterized by a clicking or snapping sensation around the wrist joint during finger or wrist motion, and bifid or trifid median nerve, which occurs in carpal tunnel syndrome along with anatomical variation of median nerve, are rare conditions. We report the case of a patient with a thickened tendon caused by severe tenosynovitis and flexor tendon subluxation to the hamate hook due to bowing of the flexor retinaculum, thereby resulting in trigger wrist as well as an anatomical median nerve variation (bifid median nerve in the right wrist and trifid median nerve in the left wrist). A 59-year-old housewife visited our hospital with bilateral fingertip numbness, tingling sensation, and aggravated severe night cramping that began 2 months ago. She also complained about trigger wrist during small finger flexion. Based on magnetic resonance imaging, ultrasonography, and nerve conduction study, trifid median nerve and bilateral severe median nerve neuropathy of the wrist were diagnosed; therefore, transverse carpal tunnel release and exploration under wide-awake anesthesia were planned. Intraoperative findings showed trifid and bifid median nerves in left and right wrists, respectively. Additionally, bowing of flexor retinaculum and severe flexor tendon tenosynovitis were observed. Tenosynovitis with thickened flexor sheath resulted in subluxation of the small finger flexor tendon above the hamate hook. After transverse carpal ligament release with antebrachial fascia release and tenosynovectomy, subluxation of the flexor tendon was resolved. At 6 months postoperatively, the tingling and dullness in fingertips also resolved, and no trigger wrist or any other complications were noted.

Anatomical Study of the Close Association between Latissimus Dorsi and Surrounding Muscles. How to Safely Harvest the Muscle?

Background We suggested an easy and effective harvesting technique to avoid injury to tissues adjacent to the latissimus dorsi (LD). Methods Between 2007 and 2017, breast reconstruction was performed with an LD flap using the "bottom-up" technique. Medical records were retrospectively reviewed. Data on postoperative complications, results, and follow-up were obtained. Nine cadaveric dissections were performed to assess positional relationships between LD and adjacent muscles based on the ribs where relevant muscles and LD attach. Overall, 78 LD flaps were harvested without complications. Results Average age was 45.4 years. The mean operation time was 260 minutes. There were no abnormalities or injuries in the adjacent fascia and muscles during the flap harvest. Drains were removed at an average of 21.9 days postoperatively. In all cadavers, there was conjoined fascia between the thoracolumbar and LD fasciae. The average level of the merging point between the LD and external oblique muscle (EOM) was 8.9 to 11.1 ribs. The average level of the overlapping point between the LD and serratus posterior inferior (SPI) was 9.5 to 11.1 ribs. Conclusions There are three dangerous zones during LD flap harvesting. The first zone is where the conjoined fascia encompasses the LD and thoracolumbar fasciae. The second zone is where the LD merges with the EOM and the serratus anterior. The third zone is the lower part where the LD merges with the SPI and EOM. The "bottom-up" technique enables a more meticulous and atraumatic operation by beginner flap surgeons.

Deep visual domain adaptation and semi-supervised segmentation for understanding wave elevation using wave flume video images.

Accurate water surface elevation estimation is essential for understanding nearshore processes, but it is still challenging due to limitations in measuring water level using in-situ acoustic sensors. This paper presents a vision-based water surface elevation estimation approach using multi-view datasets. Specifically, we propose a visual domain adaptation method to build a water level estimator in spite of a situation in which ocean wave height cannot be measured directly. We also implemented a semi-supervised approach to extract wave height information from long-term sequences of wave height observations with minimal supervision. We performed wave flume experiments in a hydraulic laboratory with two cameras with side and top viewpoints to validate the effectiveness of our approach. The performance of the proposed models were evaluated by comparing the estimated time series of water elevation with the ground-truth wave gauge data at three locations along the wave flume. The estimated time series were in good agreement within the averaged correlation coefficient of 0.98 and 0.90 on the measurement and 0.95 and 0.85 on the estimation for regular and irregular waves, respectively.

Evaluation of the International Society for Cutaneous Lymphoma Algorithm for the Diagnosis of Early Mycosis Fungoides.

The International Society for Cutaneous Lymphoma (ISCL) proposes a diagnostic algorithm for early mycosis fungoides (MF) that includes clinical, histological, immunophenotypical, and molecular criteria. Here, we analyzed the immunologic markers and features of T-cell clonality in 38 early MF cases and 22 non-MF cases to validate the ISCL algorithm. We found that CD5 and CD7 expression differed significantly between early MF and non-MF cases, with epidermal discordance of CD7 expression more frequently identified in early MF. Notably, increasing the cut-off value for CD7 expression from 10% to 22.5% improved its sensitivity. Furthermore, TCR-γ and ß chain rearrangements were more frequently detected in early MF than in non-MF cases. Based on these findings, we propose CD5 and CD7 deficiency as mandatory immunopathologic criteria and PCR-based testing for TCR-γ and ß chains as required molecular/biologic criteria to improve the efficiency of early MF diagnosis using the ISCL algorithm.

Optimal treatment recommendations for diabetes patients using the Markov decision process along with the South Korean electronic health records.

The extensive utilization of electronic health records (EHRs) and the growth of enormous open biomedical datasets has readied the area for applications of computational and machine learning techniques to reveal fundamental patterns. This study's goal is to develop a medical treatment recommendation system using Korean EHRs along with the Markov decision process (MDP). The sharing of EHRs by the National Health Insurance Sharing Service (NHISS) of Korea has made it possible to analyze Koreans' medical data which include treatments, prescriptions, and medical check-up. After considering the merits and effectiveness of such data, we analyzed patients' medical information and recommended optimal pharmaceutical prescriptions for diabetes, which is known to be the most burdensome disease for Koreans. We also proposed an MDP-based treatment recommendation system for diabetic patients to help doctors when prescribing diabetes medications. To build the model, we used the 11-year Korean NHISS database. To overcome the challenge of designing an MDP model, we carefully designed the states, actions, reward functions, and transition probability matrices, which were chosen to balance the tradeoffs between reality and the curse of dimensionality issues.

Open carpal release using local anesthesia without a tourniquet: Does bleeding tendency affect the outcome?

BACKGROUND: The aim of this study was to analyze the clinical results of minimal single palmar-incision carpal tunnel release without a tourniquet. METHODS: We reviewed the medical records of 75 patients (90 cases of carpal tunnel syndrome) who underwent minimal single-palmar incision carpal tunnel release without a tourniquet from June 2010 to January 2018. Ten patients had a bleeding tendency. We compared the preoperative and postoperative Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores. We also analyzed outcomes and complications according to the presence of a bleeding tendency. RESULTS: In all cases, there was a complete disappearance or marked improvement in symptoms within 6 months, with no recurrence. The postoperative BCTQ score showed a significant improvement compared to the preoperative score, and no statistically significant difference in BCTQ scores was detected according to the presence of a bleeding tendency. CONCLUSIONS: Carpal tunnel release without a tourniquet using a minimal single palmar incision is effective and reliable. This technique prevents unnecessary pain associated with the tourniquet and is especially helpful in patients with a bleeding tendency or those treated with hemodialysis.

Subsystem Hazard Analysis on an Offshore Waste Disposal Facility.

Offshore waste disposal facilities are unique marine infrastructures that exist only in a few countries. Although the existing facilities in Japan and Singapore have been successfully operated in general, there have been no investigations on the probable hazards they pose on the environment. Considering this, conceivable hazards were identified for an offshore waste disposal facility that has recently been proposed in Korea. The causes and consequences of each of the identified hazards were analyzed to seek countermeasures for reducing the environmental impact in advance. Hazards of waste disposal facilities can be classified according to their design, construction, maintenance, operation, and site utilization. For these areas, except for site utilization, subsystem hazard analysis was performed. In the initial assessment, seven elements were found to be in the extreme risk zone, 30 were in the high-risk zone, and six were in the moderate-risk zone. After applying the alternative mitigation methods, the final risk assessment resulted in 27 moderate-risk and 16 low-risk elements. Therefore, it was confirmed that the potential risks of the proposed offshore waste disposal facility were within acceptable ranges.

Prometheus, an omics portal for interkingdom comparative genomic analyses.

Functional analyses of genes are crucial for unveiling biological responses, genetic engineering, and developing new medicines. However, functional analyses have largely been restricted to model organisms, representing a major hurdle for functional studies and industrial applications. To resolve this, comparative genome analyses can be used to provide clues to gene functions as well as their evolutionary history. To this end, we present Prometheus, a web-based omics portal that contains more than 17,215 sequences from prokaryotic and eukaryotic genomes. This portal supports interkingdom comparative analyses via a domain architecture-based gene identification system and Gene Search, and users can easily and rapidly identify single or entire gene sets in specific pathways. Bioinformatics tools for further analyses are provided in Prometheus or through Bio-Express, a cloud-based bioinformatics analysis platform. Prometheus is a new paradigm for comparative analyses of large amounts of genomic information.

Risk of necrosis in the adjacent toe after one-toe fillet flap in diabetic foot: Retrospective study of 107 cases over 5 years.

PURPOSE: Fillet flap is a "spare part" concept. This technique allows the defect to be covered without donor site morbidity. Over the past 5 years, there were 107 diabetic foot cases of one-toe fillet flap in our hospital. After the operation, in some patients, there was necrosis of the adjacent toe that required additional amputation. The aim of our study was to determine the cause of necrosis of the adjacent toe after fillet flap. METHODS: The patients were divided into two groups. One group had no necrosis of the adjacent toe (group A) after the operation, and the other group had necrosis of the adjacent toe that required additional amputation after the operation (group B). Then, to confirm the cause of the additional necrosis of the adjacent toe, χ2 tests, Fisher's tests, and logistic regression tests were performed. RESULTS: A total of 107 patients were included, and 48 patients needed additional amputation. The logistic regression test revealed that a fillet flap at the metatarsophalangeal joint (MTPJ), horizontal sutures, and a fillet flap at the second toe were significant risk factors for developing necrosis. CONCLUSIONS: If a fillet flap with a second toe, fillet flap on MTPJ level and horizontal closure after fillet flap is needed, the chance of developing necrosis of the adjacent toe and additional revisional surgery must be communicated preoperatively.

Meningothelial hamartoma of the scalp.

Meningothelial hamartoma is a benign tumor composed of ectopic meningothelial elements in the dermis and subcutaneous tissue. It mainly occurs in the scalp; however, the incidence is extremely low. The origin of meningothelial hamartoma has not been elucidated; nevertheless, it has been theorized that it derives from ectopic meningothelial rests displaced during embryologic development. It can be diagnosed histologically as proliferation of connective tissue elements and cells arranged in solid nests, resembling vascular tumors. On immunohistochemistry, it stains positively for epithelial membrane antigen and vimentin. At least 17 cases have been reported, verifying the rarity of the lesion. We present the case of a 16-year-old male patient with a soft scalp mass which was thought to be a lipoma, but turned out to be a meningothelial hamartoma on histology.

Comprehensive analysis of Translationally Controlled Tumor Protein (TCTP) provides insights for lineage-specific evolution and functional divergence.

BACKGROUND: Translationally controlled tumor protein (TCTP) is a conserved, multifunctional protein involved in numerous cellular processes in eukaryotes. Although the functions of TCTP have been investigated sporadically in animals, invertebrates, and plants, few lineage-specific activities of this molecule, have been reported. An exception is in Arabidopsis thaliana, in which TCTP (AtTCTP1) functions in stomatal closuer by regulating microtubule stability. Further, although the development of next-generation sequencing technologies has facilitated the analysis of many eukaryotic genomes in public databases, inter-kingdom comparative analyses using available genome information are comparatively scarce. METHODOLOGY: To carry out inter-kingdom comparative analysis of TCTP, TCTP genes were identified from 377 species. Then phylogenetic analysis, prediction of protein structure, molecular docking simulation and molecular dynamics analysis were performed to investigate the evolution of TCTP genes and their binding proteins. RESULTS: A total of 533 TCTP genes were identified from 377 eukaryotic species, including protozoa, fungi, invertebrates, vertebrates, and plants. Phylogenetic and secondary structure analyses reveal lineage-specific evolution of TCTP, and inter-kingdom comparisons highlight the lineage-specific emergence of, or changes in, secondary structure elements in TCTP proteins from different kingdoms. Furthermore, secondary structure comparisons between TCTP proteins within each kingdom, combined with measurements of the degree of sequence conservation, suggest that TCTP genes have evolved to conserve protein secondary structures in a lineage-specific manner. Additional tertiary structure analysis of TCTP-binding proteins and their interacting partners and docking simulations between these proteins further imply that TCTP gene variation may influence the tertiary structures of TCTP-binding proteins in a lineage-specific manner. CONCLUSIONS: Our analysis suggests that TCTP has undergone lineage-specific evolution and that structural changes in TCTP proteins may correlate with the tertiary structure of TCTP-binding proteins and their binding partners in a lineage-specific manner.

Correlation between the inframammary fold and sixth rib: Application to breast reconstruction.

The inframammary fold (IMF) is an essential aesthetic element that influences the outcome of breast surgery. In this study, we introduced a new method for finding the IMF based on retrospective analysis of chest computed tomography (CT) scans of women's breasts. Sagittal sections of 80 female chest CTs were analyzed. Sagittal sections of 80 female chest CTs were analyzed by a single plastic surgeon. The distances between the fifth, sixth, and seventh ribs and the IMF were measured using Photoshop, and the location of the IMF was statistically analyzed according to age and height using paired t tests and Pearson's correlation test. As determined by our new method, the average distance between the IMF and the sixth rib was 5.33 mm, which was less than that between the IMF and any other rib. The IMF was closest to the sixth rib in all age groups (P < 0.001), and all IMFs were located between 39.5 mm superior and 24 mm inferior to the sixth rib. The sixth rib, one of the most visible reference structures in women's surface anatomy, is the "sentinel rib" for the IMF and the most predictive indicator of the location of the IMF. Knowing the original anatomic location of the IMF will enable better outcomes during breast surgery. Clin. Anat. 33:165-172, 2020. © 2019 Wiley Periodicals, Inc.

Src inhibition induces melanogenesis in human G361 cells.

The Src kinase family (SKF) includes non­receptor tyrosine kinases that interact with many cellular cytosolic, nuclear and membrane proteins, and is involved in the progression of cellular transformation and oncogenic activity. However, there is little to no evidence on the effect of SKF or its inhibitors on melanogenesis. Therefore, the present study investigated whether C­terminal Src kinase inhibition can induce melanogenesis and examined the associated signaling pathways and mRNA expression of melanogenic proteins. First, whether stimulators of melanogenesis, such as ultraviolet B and α­melanocyte­stimulating hormone, can dephosphorylate Src protein was evaluated, and the results revealed that SU6656 and PP2 inhibited the phosphorylation of Src in G361 cells. Src inhibition by these chemical inhibitors induced melanogenesis in G361 cells and upregulated the mRNA expression levels of melanogenesis­associated genes encoding microphthalmia­associated transcription factor, tyrosinase­related protein 1 (TRP1), TRP2, and tyrosinase. In addition, Src inhibition by small interfering RNA induced melanogenesis and upregulated the mRNA expression levels of melanogenesis­associated genes. As the p38 mitogen­activated protein kinase (MAPK) and cyclic adenosine monophosphate response element binding (CREB) pathways serve key roles in melanogenesis, the present study further examined whether Src mediates melanogenesis via these pathways. As expected, Src inhibition via SU6656 or PP2 administration induced the phosphorylation of p38 or CREB, as determined by western blotting analysis, and increased the levels of phosphorylated p38 or CREB, as determined by immunofluorescence staining. In addition, the induced pigmentation and melanin content of G361 cells by Src inhibitors was significantly inhibited by p38 or CREB inhibitors. Taken together, these data indicate that Src is associated with melanogenesis, and Src inhibition induces melanogenesis via the MAPK and CREB pathways in G361 cells.

Subsegmental Osteotomy Technique With Distraction Osteogenesis for Natural Frontal Contouring in Metopic Synostosis.

Vectoring issues occur due to the dynamics of unidirectional procedure that is selected. To circumvent such difficulties, we have devised subsegmental osteotomy with distraction. In our technique, frontal bone flap was divided into 4 segments that were linked to each other by suturing wires in an 8-year-old patient with trigonocephaly. Subsegmental osteotomy and wiring of bone flap enabled us to slide bone in a more curvilinear manner and achieve natural contour. Distraction was initiated on postoperative day 7 at the rate of 1 mm/d for 20-mm gain. At the 9-year follow-up, the patient showed improved head shape and intellectual status.

Location of the umbilicus in Korean women and its changes after breast reconstruction with an ipsilateral pedicled rectus abdominis musculocutaneous flap.

BACKGROUND: The umbilicus makes an important contribution to the natural appearance of the abdomen. To date, studies on its position in Korean women are lacking, and no standards have been established. The purpose of this study was to investigate the position of umbilicus in Korean women and to review changes in its position after ipsilateral pedicled rectus abdominis musculocutaneous (IP-RAM) flap. METHODS: This research consisted of two studies. In first study, 100 females who visited the emergency department with gastroenteritis between 2007 and 2011 were included. In second study, 40 women who underwent IP-RAM flap in the same period were included. Using abdominal computed tomography, we measured the distance between xiphoid process and umbilicus, represented by value a, and the distance between umbilicus and symphysis pubis, represented by value b. Thus, the location of the umbilicus was represented by the ratio a/b. The data were analyzed using Pearson correlation test and paired t-test. RESULTS: In study 1, the mean value of a/b was 1.07. Pearson correlation test revealed a significant correlation between age and a/b. In study 2, the mean value of a/b was 1.16 in preoperative measurements and 1.01 in postoperative measurements. The paired t-test showed a significant difference between preoperative and postoperative measurements, indicating cephalic migration of the umbilicus after surgery. CONCLUSIONS: The natural position of the umbilicus showed caudal migration with aging. Additionally, in a comparison of preoperative and postoperative measurements in patients who underwent IP-RAM flap, cephalic migration of the umbilicus was observed after surgery.

Comparison of Pedal Soft Tissue Thickness Between Those With and Without Diabetes.

Ulceration is a serious consequence of diabetes that can lead to disability in patients with diabetes. One of the risk factors for ulceration is high foot pressure. The thickness of the pedal soft tissue is important because it has a cushioning effect. Soft tissue atrophy causes elevation in the plantar pressure, which, in turn, causes ischemia. Therefore, we investigated the severity of pedal soft tissue atrophy caused by diabetes and aging. From February 2009 to February 2016, we examined the feet of 261 patients treated in our hospital using magnetic resonance imaging. We divided the patients enrolled in the study into 2 groups. The first group included 52 patients with diabetes but without peripheral arterial disease and the second group included 47 patients without diabetes. We measured the vertical distances under all patients' metatarsal heads using T1-weighted magnetic resonance imaging and measured the pedal soft tissue thickness using the PACS workstation (m-view). We compared the soft tissue thicknesses of the 2 groups and performed statistical analyses of the relationships between these data and other parameters using 2-way analysis of variance. The soft tissue under the first to fourth metatarsal heads was thinner in the diabetic patients than in the nondiabetic patients (first metatarsal, 6.4 versus 8.69; second metatarsal, 8.85 versus 10.64; third metatarsal, 8.15 versus 9.21; fourth metatarsal, 7.38 versus 8.54; p < .05). Aging had no effect on pedal soft tissue atrophy in either group. In conclusion, our study confirmed that diabetic patients experience more severe plantar soft tissue atrophy than nondiabetic patients. We have developed a standard procedure to enable the prediction of pedal soft tissue atrophy severity in diabetic patients.