Comparison of the Prevalence of Low Back Pain and Related Spinal Diseases among Smokers and Nonsmokers: Using Korean National Health Insurance Database

Background@#To compare the risk of low back pain (LBP) and related spinal diseases between smokers (exposure group) and nonsmokers (non-exposure group). No large registry study has so far investigated the association between smoking and LBP-related spinal diseases such as intervertebral disc disease, spinal stenosis, spinal instability, and spondylolisthesis. @*Methods@#A random sample was taken from the Korean National Health Insurance Research Database. In total, 204,066 men (160,105 smokers, 43,961 nonsmokers) who were followed up between 2002 and 2013 were included in the analysis. Patients with previous back pain or spinal disease in 2003 and 2004, patients with inappropriate data, and women (due to the lower percentage of smokers) were excluded. The Cox proportional hazard model was used to investigate the risk of LBP and related spinal diseases associated with smoking, while adjusting for demographic, clinical, and socioeconomic factors. @*Results@#The overall median follow-up period was 5.6 years (interquartile range, 3.48–8.43 years). Compared to the nonsmoker group, the smoker group had a higher incidence of LBP (p = 0.01), intervertebral disc disease (p < 0.001), spinal stenosis (p = 0.004), spinal instability (p < 0.001), and spondylolisthesis (p = 0.023). Compared to the nonsmoker group, the smoker group had a higher adjusted hazard ratio (HR) per year of LBP (HR, 1.18; 95% confidence interval [CI], 1.15 to 1.21), intervertebral disc disease (HR, 1.25; 95% CI, 1.21 to 1.30), spinal stenosis (HR, 1.52; 95% CI, 1.41 to 1.64), spinal instability (HR, 1.33; 95% CI, 1.24 to 1.44), and spondylolisthesis (HR, 1.49; 95% CI, 1.23 to 1.80). @*Conclusions@#Smokers in male samples were at higher risk for LBP and related spinal diseases than nonsmokers.

Cathelicidin-related Antimicrobial Peptide Contributes to Host Immune Responses Against Pulmonary Infection with Acinetobacter baumannii in Mice

Acinetobacter baumannii is known for its multidrug antibiotic resistance. New approaches to treating drug-resistant bacterial infections are urgently required. Cathelicidin-related antimicrobial peptide (CRAMP) is a murine antimicrobial peptide that exerts diverse immune functions, including both direct bacterial cell killing and immunomodulatory effects. In this study, we sought to identify the role of CRAMP in the host immune response to multidrug-resistant Acinetobacter baumannii. Wild-type (WT) and CRAMP knockout mice were infected intranasally with the bacteria. CRAMP−/− mice exhibited increased bacterial colony-forming units (CFUs) in bronchoalveolar lavage (BAL) fluid after A. baumannii infection compared to WT mice. The loss of CRAMP expression resulted in a significant decrease in the recruitment of immune cells, primarily neutrophils. The levels of IL-6 and CXCL1 were lower, whereas the levels of IL-10 were significantly higher in the BAL fluid of CRAMP−/− mice compared to WT mice 1 day after infection. In an in vitro assay using thioglycollate-induced peritoneal neutrophils, the ability of bacterial phagocytosis and killing was impaired in CRAMP−/− neutrophils compared to the WT cells. CRAMP was also essential for the production of cytokines and chemokines in response to A. baumannii in neutrophils. In addition, the A. baumannii-induced inhibitor of κB-α degradation and phosphorylation of p38 MAPK were impaired in CRAMP−/− neutrophils, whereas ERK and JNK phosphorylation was upregulated. Our results indicate that CRAMP plays an important role in the host defense against pulmonary infection with A. baumannii by promoting the antibacterial activity of neutrophils and regulating the innate immune responses.

Nucleotide-binding oligomerization domain 1 is dispensable for host immune responses against pulmonary infection of Acinetobacter baumannii in mice / 한국실험동물학회지

Nucleotide-binding domain 1 (Nod1) is a cytosolic receptor that is responsible for the recognition of a bacterial peptidoglycan motif containing meso-diaminophimelic acid. In this study, we sought to identify the role of Nod1 in host defense in vivo against pulmonary infection by multidrug resistant Acinetobacter baumannii. Wildtype (WT) and Nod1-deficient mice were intranasally infected with 3×107 CFU of A. baumannii and sacrificed at 1 and 3 days post-infection (dpi). Bacterial CFUs, cytokines production, histopathology, and mouse β-defensins (mBD) in the lungs of infected mice were evaluated. The production of cytokines in response to A. baumannii was also measured in WT and Nod1-deficient macrophages. The bacterial clearance in the lungs was not affected by Nod1 deficiency. Levels of IL-6, TNF-α, and IL-1β in the lung homogenates were comparable at days 1 and 3 between WT and Nod1-deficient mice, except the TNF-α level at day 3, which was higher in Nod1-deficient mice. There was no significant difference in lung pathology and expression of mBDs (mBD1, 2, 3, and 4) between WT and Nod1-deficient mice infected with A. baumannii. The production of IL-6, TNF-α, and NO by macrophages in response to A. baumannii was also comparable in WT and Nod1-deficient mice. Our results indicated that Nod1 does not play an important role in host immune responses against A. baumannii infection.

Clinical value of routine serum squamous cell carcinoma antigen in follow-up of patients with locally advanced cervical cancer treated with radiation or chemoradiation

OBJECTIVE: The objective of this study was to evaluate the clinical benefits of routine squamous cell carcinoma antigen (SCC-Ag) monitoring of patients with locally advanced cervical squamous cell carcinoma treated with radiation or chemoradiation. METHODS: A total of 53 patients with recurrent cervical squamous cell carcinoma treated with radiotherapy or chemoradiation were enrolled in this study. A retrospective review of medical records was conducted. The role of routine monitoring of serum SCC-Ag was evaluated in terms of cost effectiveness and effect on survival after diagnosis of recurrence. RESULTS: Serum SCC-Ag abnormality (≥2.5 ng/mL) was observed in 62.3% of patients when recurrent disease was diagnosed. The first indicator of relapse was abnormal serum SCC-Ag level in 21 patients (39.6%), 10 of whom had asymptomatic recurrent disease amenable to salvage therapy. Adding SCC-Ag measurement to the basic follow up protocol improved the sensitivity for detecting recurrence (The sensitivity of the basic protocol vs. addition of SCC-Ag: 49.1% vs. 88.7%, P<0.001). Twenty-three patients who were candidates for salvage therapy with curative intent showed better survival compared with those who were not candidates for therapy (5-year survival: 36.6% vs. 0%, P=0.012). CONCLUSION: Surveillance with routine serum SCC-Ag monitoring can better detect asymptomatic recurrent disease that is potentially amenable to salvage therapy with curative intent. Early diagnosis of recurrent disease that can be treated with salvage therapy may lead to better survival.

Development and validation of novel digitalized cervicography system

OBJECTIVE: Digital cervicography systems would be expected to reduce the costs of film cervicography, and provide the opportunity for "telemedicine-based" screening. We aimed to develop web-based digital cervicography system, and validate it compared with conventional film cervicography. METHODS: A hundred cases from five centers were prospectively included, and cervical images (analogue, digitalized by scanning analogue, and digital) were taken separately using both analogue (Cerviscope) and digital camera (Dr. Cervicam) in each patient. Nine specialists evaluated the three kinds of images of each case with time interval between evaluations of each image. To validate novel digitalized system, we analyzed intra-observer variance among evaluation results of three kinds of images. RESULTS: Sixty-three cases were finally analyzed after excluding technically defective cases that cannot be evaluable on analogue images. The generalized kappa for analogue versus digital image was 0.83, for analogue versus scanned image 0.72, and for digital versus scanned image was 0.71; all were in excellent consensus. CONCLUSION: Digitalized cervicography system can be substituted for the film cervicography very reliably, and can be used as a promising telemedicine tool for cervical cancer screening.

Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic morcellation

Endometrioid stromal sarcoma is a rare malignancy that originates from mesenchymal cells. It is classified into low-grade endometrioid stromal sarcoma (LGESS) and high-grade endometrioid stromal sarcoma. Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma. Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis. Here, we report a patient with LGESS who underwent a supracervical hysterectomy and electronic morcellation for a presumed myoma in another hospital. Disseminated metastatic lesions of LGESS in the posterior cul-de-sac and rectal serosal surface were absent on primary surgery, but found during reexploration. In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.

A Case of IgG4-Related Sclerosing Mesenteritis Associated with Crohn's Disease / 대한소화기학회지

Sclerosing mesenteritis (SM) is a rare disease characterized by chronic nonspecific mesenteric inflammation and fibrosis of unknown etiology. Some tumefactive SM shows diffuse accumulation of IgG4-positive plasma cells and is considered as a part of the spectrum of IgG4-related disease. An association between inflammatory bowel disease and IgG4-related disease has been indicated. A 45-year-old woman visited our hospital due to weight loss with intermittent lower abdominal discomfort. Pelvic ultrasound revealed a mass-like lesion in the abdominal wall and pelvis MRI demonstrated a 5.9 cm sized wall-enhancing mass with heterogeneous signal intensity from right adnexa to the abdominal wall. Tumor resection and adhesiolysis was done because of severe adhesion with the small bowel, colon, bladder, uterus, and abdominal wall. Appendectomy was also performed due to adhesion and edematous change. Histological examination of the resected mass showed findings that were compatible with IgG4-related SM. The resected appendix showed chronic granulomatous inflammation without evidence of tuberculosis. She was diagnosed with Crohn's disease after undergoing colonoscopy and CT enterography. Herein, we report a rare case of IgG4-related SM that occurred in conjunction with Crohn's disease.

Trunk Muscles Strength as a Risk Factor for Nonspecific Low Back Pain: A Pilot Study

OBJECTIVE: To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP). METHODS: Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined. RESULTS: Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence. CONCLUSION: LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.

Trunk Muscles Strength as a Risk Factor for Nonspecific Low Back Pain: A Pilot Study

OBJECTIVE: To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP). METHODS: Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined. RESULTS: Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence. CONCLUSION: LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.

High expression of epidermal growth factor-like domain 7 is correlated with poor differentiation and poor prognosis in patients with epithelial ovarian cancer / 부인종양

OBJECTIVE: The purpose of this study was to evaluate the expression of epidermal growth factor-like domain 7 (EGFL7) in epithelial ovarian cancer, and to assess its relevance to clinicopathological characteristics and patients' survival. METHODS: A total of 177 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for EGFL7 was performed using tissue microarrays made with paraffin-embedded tissue block. EGFL7 expression levels were graded on a grade of 0 to 3 based on the percentage of positive cancer cells. We analyzed the correlations between the expression of EGFL7 and various clinical parameters, and also analyzed the survival outcome according to the EGFL7 expression. RESULTS: The expression of EGFL7 in ovarian cancer tissues was observed in 98 patients (55.4%). High expression of EGFL7 (grade 2 or 3) was significantly correlated with pathologic type, differentiation, stage, residual tumor after debulking surgery, lymphovascular space involvement, lymph node metastasis, high cancer antigen 125, peritoneal cytology, and ascites. Among these clinicopathologic factors, differentiation was significantly correlated with EGFL7 expression in multivariate analysis (p<0.05). Survival analysis showed that the patients with high EGFL7 expression had a poorer disease free survival than those with low EGFL7 expression (p=0.002). CONCLUSION: Our data suggest that EGFL7 expression is a novel predictive factor for the clinical progression of epithelial ovarian cancer, and may constitute a therapeutic target for antiangiogenesis therapy in patients with epithelial ovarian cancer.

Overexpression of CD73 in epithelial ovarian carcinoma is associated with better prognosis, lower stage, better differentiation and lower regulatory T cell infiltration / 부인종양

OBJECTIVE: The purpose of the current study was to evaluate survival outcome according to the expression status of CD73 in patients with epithelial ovarian cancer. METHODS: A total of 167 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for CD73, CD8, FoxP3, and CD68 was performed using tissue microarray made with paraffin embedded tissue block. RESULTS: Among the enrolled patients, 29.9% of patients (n=50) showed negative expression for CD73, whereas 70.1% of patients (n=117) showed positive expression for CD73. The CD73 positive group showed better prognosis compared to the CD73 negative group (5-year overall survival of CD73 positive group, 73.0%; that of CD73 negative group, 50.1%; p=0.023). CD73 was more frequently expressed in mucinous adenocarcinoma and clear cell carcinoma compared to serous or endometrioid adenocarcinoma. In addition, CD73 overexpressions were more frequently detected in patients with known good prognostic factors, i.e., low stage, well/moderate differentiation, negative peritoneal cytology, no lymphovascular involvement, and no macroscopic residual tumor after debulking surgery. There was significantly more infiltration of regulatory T cells in the CD73 negative group compared to the CD73 positive group. CONCLUSION: Good prognosis in patients with overexpression of CD73 may be due to that overexpression of CD73 was more frequently observed in epithelial ovarian cancer patients with known good prognostic factors. Therefore, this result means that favorable differentiation and stage have more influence on survival outcome than adverse effect of CD73 per se.

Overexpression of CD73 in epithelial ovarian carcinoma is associated with better prognosis, lower stage, better differentiation and lower regulatory T cell infiltration / 부인종양

OBJECTIVE: The purpose of the current study was to evaluate survival outcome according to the expression status of CD73 in patients with epithelial ovarian cancer. METHODS: A total of 167 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for CD73, CD8, FoxP3, and CD68 was performed using tissue microarray made with paraffin embedded tissue block. RESULTS: Among the enrolled patients, 29.9% of patients (n=50) showed negative expression for CD73, whereas 70.1% of patients (n=117) showed positive expression for CD73. The CD73 positive group showed better prognosis compared to the CD73 negative group (5-year overall survival of CD73 positive group, 73.0%; that of CD73 negative group, 50.1%; p=0.023). CD73 was more frequently expressed in mucinous adenocarcinoma and clear cell carcinoma compared to serous or endometrioid adenocarcinoma. In addition, CD73 overexpressions were more frequently detected in patients with known good prognostic factors, i.e., low stage, well/moderate differentiation, negative peritoneal cytology, no lymphovascular involvement, and no macroscopic residual tumor after debulking surgery. There was significantly more infiltration of regulatory T cells in the CD73 negative group compared to the CD73 positive group. CONCLUSION: Good prognosis in patients with overexpression of CD73 may be due to that overexpression of CD73 was more frequently observed in epithelial ovarian cancer patients with known good prognostic factors. Therefore, this result means that favorable differentiation and stage have more influence on survival outcome than adverse effect of CD73 per se.

A Case of Cyclic Vomiting Syndrome Responding to Gonadotropin-Releasing Hormone Analogue

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent episodes of incapacitating nausea and vomiting interspersed with symptom free periods. Common triggers of cyclic vomiting include noxious stress, excitement, fatigue and menstrual period. Here, we report a case of cyclic vomiting syndrome in adult patient characterized by stereotypical vomiting attack, occurring in every menstruation period. Recurrent vomiting episodes began 6 years ago and we treated this patient with subcutaneous injection of goserelin, a gonadotropin-releasing hormone analogue (GnRHa) and oral estrogen. After 4 months of therapy, she was symptom free for the following 5 years, even with the resumed normal menstruation. Recurrence of vom - iting attack with same pattern occurred 1 month before readmission. Treatment with intravenous lorazepam aborted vomiting, but could not prevent recurrences of vomiting and epigastric pain. We treated the patient with GnRHa and oral estradiol again which effectively prevented recurrence of the symptoms.

Disseminated peritoneal leiomyomatosis arising after laparoscopic myomectomy / 대한산부인과학회지

Disseminated peritoneal leiomyomatosis is rare condition characterized by multiple subperitoneal nodules of benign smooth muscle proliferations. It is associated with high level of estrogen such as pregnancy, oral contraceptives or estrogen producing ovarian tumor, and occasionally associated with operation history of myomectomy or hysterectomy. Clinical course of disseminated peritoneal leiomyomatosis is usually benign, but malignant changes also rarely have been reported. We experienced a case of disseminated peritoneal leiomyomatosis who has history of laparoscopic myomectomy 10 years ago. The patient was a 35-year-old woman, and her chief complaint was palpable masses in lower abdomen. She underwent laparoscopic surgery which revealed numerous solid masses on the surface of peritoneum, descending colon, rectosigmoid colon, uterus, round ligament, and broad ligament. We present it with a brief review of literature.

A case of mucinous adenocarcinoma arising from retroperitoneal teratoma treated with chemoradiation / 부인종양

Retroperitoneal teratoma with malignant transformation is a rare condition in adults. Its most common malignant transformation is into a squamous cell carcinoma, but rarely into a mucinous adenocarcinoma. Postoperative treatment of mucinous adenocarcinoma arising from teratomas has not been established due to its rare incidence. Here we present a case of retroperitoneal mucinous adenocarcinoma arising from a teratoma in the presacral area. Operative and postoperative managements are described with a brief review of the literatures.

A case of omental dermoid cyst due to an ovarian autoamputation / 대한산부인과학회지

The dermoid cysts occur most frequently in the ovary and are extremely rare in the greater omentum. We report a case of dermoid cyst of the greater omentum misdiagnosed as right ovarian cyst. She was a 27-year-old woman with an omental dermoid cyst of 6 cm in diameter in the cul-de-sac, and the tumor was resected laparoscopically. The histopathologic diagnosis was dermoid cyst and no evidence of malignancy was noted. The patient had no right ovary and tube. These findings demonstrated possible autoamputation of an ovary with dermoid cyst.

A case of squamous cell carcinoma arising from ovarian mature cystic teratoma treated with adjuvant chemoradiation / 대한산부인과학회지

Malignant transformation of mature cystic teratoma is rare and difficult to diagnose preoperatively. Therefore, in the suspected case considering the age, tumor size and imaging findings, it is important to diagnose intraoperatively through a frozen section biopsy. It is clear that aggressive optimal surgical resection should be done in the squamous cell carcinoma arising from mature cystic teratoma. However it is controversy what postoperative adjuvant therapy is optimal in the locally advanced case because of its rarity. We report a case of a 59-year-old woman in the menopause with locally advanced squamous cell carcinoma arising from left ovarian mature cystic teratoma treated with optimal cytoreductive surgery followed by concurrent chemoradiation.

A case of squamous cell carcinoma arising from ovarian mature cystic teratoma treated with adjuvant chemoradiation / 대한산부인과학회지

Malignant transformation of mature cystic teratoma is rare and difficult to diagnose preoperatively. Therefore, in the suspected case considering the age, tumor size and imaging findings, it is important to diagnose intraoperatively through a frozen section biopsy. It is clear that aggressive optimal surgical resection should be done in the squamous cell carcinoma arising from mature cystic teratoma. However it is controversy what postoperative adjuvant therapy is optimal in the locally advanced case because of its rarity. We report a case of a 59-year-old woman in the menopause with locally advanced squamous cell carcinoma arising from left ovarian mature cystic teratoma treated with optimal cytoreductive surgery followed by concurrent chemoradiation.

Comparison of concurrent chemoradiotherapy with cisplatin plus 5-fluorouracil versus cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma / 부인종양

OBJECTIVE: The aim of this study was to compare survival outcomes and toxicities between concurrent radiotherapy with cisplatin plus 5-fluorouracil and that with cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma. METHODS: We retrospectively reviewed data from 93 locally advanced cervical carcinoma patients (stage IB to IVA) who had been treated by concurrent radiotherapy with cisplatin plus 5-fluorouracil (CF, n=45) vs. cisplatin plus paclitaxel (CP, n=48) as primary therapy. Toxicities and survival outcomes were compared. RESULTS: In the CP group, there were higher frequencies of severe (grade 3 or 4) leukopenia (79.2%, as compared to 11.1% in the CF group), severe neutropenia (77.1%, as compared to 8.9% in the CF group) and severe peripheral neuropathy (12.5%, as compared to 2.2% in the CF group). In the CF group, there were higher frequencies of severe nausea (33.3%, as compared to 14.6% in the CP group) and severe hyponatremia (11.1%, as compared to 0% in the CP group). Five-year DFS of the CF and CP groups was 67.4% and 79.1%, respectively (p=NS). Five year OS of the CF and CP groups was 79.6% and 80.9%, respectively (p=NS). CONCLUSION: Concurrent radiotherapy with cisplatin plus paclitaxel showed increased leukopenia, neutropenia and peripheral neuropathy, but less gastrointestinal toxicity (nausea) than that with cisplatin plus 5-fluorouracil. Survival outcome between these two groups was not statistically different in this study. Large prospective randomized controlled studies will be needed to confirm this result.

Therapeutic Effect of Pamidronate on the Post-Stroke ReflexSympathetic Dystrophy

OBJECTIVE: To evaluate the effects of pamidronate on post-stroke reflex sympathetic dystrophy (RSD). METHOD: Twenty four subacute stroke patients who fulfilled Kozin's criteria of RSD were enrolled in this study. Mixed with 500 ml of 5% glucose saline, 60 mg of pamidronate was intravenously administered daily for 3 consecutive days to make total dose of 180 mg. Clinical scores of the pain and swelling and the circumference of the middle finger were measured just before, 1 and 2 weeks after the injections. Three phase bone scintigraphy and bone densitometry (BMD) were performed before and 2 weeks after pamidronate injections. RESULTS: Clinical scores of the pain and swelling and the circumference of the middle finger improved significantly after pamidronate injections. The ratio of radioisotope uptake decreased in both blood pool and delayed phase images. BMD of ultradistal radius of the involved arm significantly increased after pamidronate injections. Eleven subjects developed fever or myalgia. Two subjects could not complete the injections due to severe allergic skin reaction. CONCLUSION: The intravenous pamidronate injection could be an effective therapeutic tool for post-stroke RSD.