Efficacy of Pulsed Electromagnetic Therapy for Chronic Lower Back Pain: A Randomized, Double-blind, Placebo-controlled Study

This randomized, double-blind, placebo-controlled clinical trial studied the effectiveness of pulsed electromagnetic therapy (PEMT) in patients with chronic lower back pain. Active PEMT ( n = 17) or placebo treatment ( n = 19) was performed three times a week for 3 weeks. Patients were assessed using a numerical rating scale (NRS) and revised Oswestry disability scores for 4 weeks after therapy. PEMT produced significant pain reduction throughout the observation period compared with baseline values. The percentage change in the NRS score from baseline was significantly greater in the PEMT group than the placebo group at all three time-points measured. The mean revised Oswestry disability percentage after 4 weeks was significantly improved from the baseline value in the PEMT group, whereas there were no significant differences in the placebo group. In conclusion, PEMT reduced pain and disability and appears to be a potentially useful therapeutic tool for the conservative management of chronic lower back pain.

Sustained reduction of intraocular pressure by supraciliary delivery of brimonidine-loaded poly(lactic acid) microspheres for the treatment of glaucoma

Although effective drugs that lower intraocular pressure (IOP) in the management of glaucoma exist, their efficacy is limited by poor patient adherence to the prescribed eye drop regimen. To replace the need for eye drops, in this study we tested the hypothesis that IOP can be reduced for one month after a single targeted injection using a microneedle for administration of a glaucoma medication (i.e., brimonidine) formulated for sustained release in the supraciliary space of the eye adjacent to the drug's site of action at the ciliary body. To test this hypothesis, brimonidine-loaded microspheres were formulated using poly(lactic acid) (PLA) to release brimonidine at a constant rate for 35 days and microneedles were designed to penetrate through the sclera, without penetrating into the choroid/retina, in order to target injection into the supraciliary space. A single administration of these microspheres using a hollow microneedle was performed in the eye of New Zealand White rabbits and was found to reduce IOP initially by 6 mmHg and then by progressively smaller amounts for more than one month. All administrations were well tolerated without significant adverse events, although histological examination showed a foreign-body reaction to the microspheres. This study demonstrates, for the first time, that the highly-targeted delivery of brimonidine-loaded microspheres into the supraciliary space using a microneedle is able to reduce IOP for one month as an alternative to daily eye drops.

Predictive factors and clinical biomarkers for treatment in patients with chronic pain caused by osteoarthritis with a central sensitisation component

AIMS

The aim of this non-systematic review was to provide a practical guide for clinicians on the evidence for central sensitisation in chronic osteoarthritis (OA) pain and how this pain mechanism can be addressed in terms of clinical diagnosis, investigation and treatment.

METHODS

The authors undertook a non-systematic review of the literature including a MEDLINE search (search terms included central sensitisation, osteoarthritis, osteoarthrosis) for relevant and current clinical studies, systematic reviews and narrative reviews. Case reports, letters to the editor and similar literature sources were excluded. Information was organised to allow a pragmatic approach to the discussion of the evidence and generation of practical recommendations.

RESULTS

There is good evidence for a role of central sensitisation in chronic OA pain in a subgroup of patients. Clinically, a central sensitisation component in chronic OA pain can be suspected based on characteristic pain features and non-pain features seen in other conditions involving central sensitisation. However, there are currently no diagnostic inventories for central sensitisation specific to OA. Biomarkers may be helpful for confirming the presence of central sensitisation, especially when there is diagnostic uncertainty. Several non-pharmacological and pharmacological treatments may be effective in OA patients with central sensitisation features. Multimodal therapy may be required to achieve control of symptoms.

DISCUSSION

Clinicians should be aware of central sensitisation in patients with chronic OA pain, especially in patients presenting with severe pain with unusual features.

Disease-modifying therapeutic directions for Lewy-Body dementias

Dementia with Lewy bodies (DLB) is the second leading cause of dementia following Alzheimer's disease (AD) and accounts for up to 25% of all dementia. DLB is distinct from AD in that it involves extensive neuropsychiatric symptoms as well as motor symptoms, leads to enormous societal costs in terms of direct medical care and is associated with high financial and caregiver costs. Although, there are no disease-modifying therapies for DLB, we review several new therapeutic directions in treating DLB. We discuss progress in strategies to decrease the level of alpha-synuclein, to prevent the cell to cell transmission of misfolded alpha-synuclein, and the potential of brain stimulation in DLB.

New therapeutic strategies targeting D1-type dopamine receptors for neuropsychiatric disease

The neurotransmitter dopamine acts via two major classes of receptors, D1-type and D2-type. D1 receptors are highly expressed in the striatum and can also be found in the cerebral cortex. Here we review the role of D1 dopamine signaling in two major domains: L-DOPA-induced dyskinesias in Parkinson's disease and cognition in neuropsychiatric disorders. While there are many drugs targeting D2-type receptors, there are no drugs that specifically target D1 receptors. It has been difficult to use selective D1-receptor agonists for clinical applications due to issues with bioavailability, binding affinity, pharmacological kinetics, and side effects. We propose potential therapies that selectively modulate D1 dopamine signaling by targeting second messengers downstream of D1 receptors, allosteric modulators, or by making targeted modifications to D1-receptor machinery. The development of therapies specific to D1-receptor signaling could be a new frontier in the treatment of neurological and psychiatric disorders.

Highly oriented gold/nanoclay-polymer nanocomposites for flexible gas barrier films

Layer-by-layer (LBL) assembly, which uses electronic and ionic intermolecular bonding under nonvacuum conditions, is a promising technology for fabricating gas barrier films owing to its simple processing and easy formation of a multilayer structure. In this research, nanoclay-polymer multilayers of Na(+)-montmorillonite (Na-MMT) were fabricated. Particularly, the addition of AuCl3 on fabricated MMT layers caused a reaction with the surface silanol functional groups (Si-O-H) of the MMT platelets, resulting in the formation of Au2O3 on the MMT-polymer multilayers. The Au2O3 filled the vacancies between the MMT platelets and linked the MMT platelets together, thus forming a gas barrier film that reduced the water vapor transmission rate (WVTR) to 3.2 × 10(-3) g m(-2) day(-1). AuCl3-treated MMT-polymer multilayers thus have the potential to be utilized for manufacturing gas barrier films for flexible electronics on a large scale.

Involvement of actin microfilament in regulation of pacemaking activity increased by hypotonic stress in cultured ICCs of murine intestine

Distension is a regular mechanical stimulus in gastrointestinal (GI) tract. This study was designed to investigate the effect of hypotonic stress on pacemaking activity and determine whether actin microfilament is involved in its mechanism in cultured murine intestinal interstitial cells of Cajal (ICCs) by using whole-cell patch-clamp and calcium imaging techniques. Hypotonic stress induced sustained inward holding current from the baseline to -650+/-110 pA and significantly decreased amplitudes of pacemaker current. Hypotonic stress increased the intensity of basal fluorescence ratio (F/F0) from baseline to 1.09+/-0.03 and significantly increased Ca(2+) oscillation amplitude. Cytochalasin-B (20 microM), a disruptor of actin microfilaments, significantly suppressed the amplitudes of pacemaker currents and calcium oscillations, respectively. Cytochalasin-B also blocked hypotonic stress-induced sustained inward holding current and hypotonic stress-induced increase of calcium oscillations. Phalloidin (20 microM), a stabilizer of actin microfilaments, significantly enhanced the amplitudes of pacemaker currents and calcium oscillations, respectively. Despite the presence of phalloidin, hypotonic stress was still able to induce an inward holding current and increased the basal fluorescence intensity. These results suggest that hypotonic stress induces sustained inward holding current via actin microfilaments and the process is mediated by alteration of intracellular basal calcium concentration and calcium oscillation in cultured intestinal ICCs.

Kaposi sarcoma-associated herpesvirus promotes tumorigenesis by modulating the Hippo pathway

Kaposi sarcoma-associated herpesvirus (KSHV) is an oncogenic virus and the culprit behind the human disease Kaposi sarcoma (KS), an AIDS-defining malignancy. KSHV encodes a viral G-protein-coupled receptor (vGPCR) critical for the initiation and progression of KS. In this study, we identified that YAP/TAZ, two homologous oncoproteins inhibited by the Hippo tumor suppressor pathway, are activated in KSHV-infected cells in vitro, KS-like mouse tumors and clinical human KS specimens. The KSHV-encoded vGPCR acts through Gq/11 and G12/13 to inhibit the Hippo pathway kinases Lats1/2, promoting the activation of YAP/TAZ. Furthermore, depletion of YAP/TAZ blocks vGPCR-induced cell proliferation and tumorigenesis in a xenograft mouse model. The vGPCR-transformed cells are sensitive to pharmacologic inhibition of YAP. Our study establishes a pivotal role of the Hippo pathway in mediating the oncogenic activity of KSHV and development of KS, and also suggests a potential of using YAP inhibitors for KS intervention.

Superconducting properties of hole doped Ba(0.6)Li(0.4)Fe2As2 single crystal

We report the emergence of superconductivity in Li doped Ba-122 single crystals grown by the Bridgman method. The superconducting transition temperature Tc,onset is around 19 K. The specific heat capacity C/T shows a weak anomaly near Tc. The value of ΔC/γnTc is smaller than the value predicted in BCS theory indicating a multigap nature of the sample. The magnetic measurements show that the lower critical field Hc1(T) exhibits a linear temperature dependence, with a pronounced change of the Hc1(T) curvature around 0.4Tc and Hc1(0) ≈ 430 Oe in the Ba0.6Li0.4Fe2As2 single crystal. Furthermore, temperature dependence of the penetration depth λ(T) follows a power law (~T(n)) below 0.4Tc which predicts possible S±-wave pairing in a Ba0.6Li0.4Fe2As2 superconductor. Over a wide range of temperatures, the Jc(H) exhibits a relation J(c)[proportionality] H(-α) with α = 0.5 ~ 0.6 for H || c and H || ab which indicates random defects in the sample. We found that the temperature dependence of the critical current density Jc(T) can be fitted well with the δl-type pinning model, whose origin is attributed to spatial variations of charge carrier mean free path l. We suggest that the large mismatch in the ionic radius of Ba and Li can affect the irreversible magnetic properties of the Ba0.6Li0.4Fe2As2 single crystal without any structural transition.

Multidetector CT imaging features of solid pseudopapillary tumours of the pancreas in male patients: distinctive imaging features with female patients

OBJECTIVE

To describe multidetector CT imaging features of solid pseudopapillary tumours (SPTs) in male patients and to compare these imaging features with those found in female patients.

METHODS

The institutional review board approved this retrospective study. We included the CT images of 72 patients (M:F = 12:60; mean age, 35.0 years) diagnosed with SPT by histology. CT images were reviewed on the following: location of the tumour, maximal diameter, shape, margin and the fraction of the tumour composition. Statistical differences in CT imaging features were analysed.

RESULTS

Male patients with SPTs were significantly older than female patients (42.4 years vs 33.4 years, p = 0.0408) and the mean size of the SPTs in male patients was larger (6.3 cm vs 4.6 cm, p = 0.0413) than that of SPTs in female patients. Lobulated shape of the SPTs was most frequent in male patients, whereas oval shape was most frequent in female patients (p = 0.0133). SPTs in male patients tended to have a solid component (p = 0.0434). Progressive enhancement in the solid portion of the tumour was seen in 9 (81.8%) of 11 SPTs in male patients and in 30 (79.0%) of 38 SPTs in female patients on multiphasic CT.

CONCLUSION

The imaging features of SPTs in male patients usually appeared as a somewhat large-sized solid mass with a lobulated margin and progressive enhancement. These imaging features may help to differentiate SPTs from other pancreatic tumours for their proper management.

ADVANCES IN KNOWLEDGE

SPTs in male patients appear as somewhat large-sized solid masses with lobulated margins, and this form occurs more frequently in older male patients than in female patients.

Fabrication and electrochemical properties of hemisphere structured 3D Li(Li0.2Mn0.54Co0.13Ni0.13)O2 cathode thin film for all-solid-state lithium battery

The Li[Li0.2Mn0.54Ni0.13Co0.13]O2 cathode thin films were deposited on planar, hemisphere, linked hemisphere, and isolated hemisphere structured Pt current collector thin films to investigate the effect of 3-dimensional (3-D) structure for the electrochemical properties of active cathode thin films. The films of linked hemisphere structure shows the highest initial discharge capacity of 140 microA h/cm2-microm which is better than those of planar (62 microA h/cm2-microm), hemisphere (94.6 microA h/cm2-microm), and isolated hemisphere (135 microA h/cm2-microm) films due to increase of surface area for cathode thin films. Linked hemisphere shows the biggest capacity and the best retention rate because 6 nanobridges of each hemisphere bring strong connection.

Hypopigmented keratosis: is it a hyperkeratotic variant of idiopathic guttate hypomelanosis?

We have occasionally seen patients with acquired well-demarcated, scattered hypopigmented papules. In this study, we investigated the clinical and histopathological characteristics of such lesions. Biopsies were taken from the lesional and perilesional normal skin from 10 of 13 patients, which were compared with 10 idiopathic guttate hypomelanosis (IGH) samples. The lesions were scattered, well-circumscribed, flat-topped, hypopigmented papules. There was no age or gender predilection. Marked hyperkeratosis was present, with clear-cut margins distinguishable from the adjacent normal epidermis. The melanin content was decreased in the lesional epidermis, which was associated with a decrease in expression of melanogenesis-associated markers such as tyrosinase and NKI/beteb (marker of gp100) and reduction in the number of melanocytes. These histological findings were similar to those of IGH except for the additional finding of a thicker stratum corneum in this case seem to represent a 'hyperkeratotic' variant of IGH.

Antihepatotoxic zeaxanthins from the fruits ofLycium chinense

A CHCl(3): MeOH extract of the fruit ofLycium chinense Mill. (Solanaceae) was found to afford significant protection against carbon tetrachloride-induced toxicity in primary cultures of rat hepatocytes. Subsequent activity-guided fractionation resulted in the isolation of zeaxanthin and zeaxanthin dipalmitate as antihepatotoxic components. Incubation of injured hepatocytes with zeaxanthin dipalmitate reduced the levels of glutamic pyruvic transaminase (GPT) and sorbitol dehydrogenase (SDH) released from damaged cells to 60.5% and 76.3% of those released from untreated controls, respectively. Zeaxanthin also reduced the levels of GPT and SDH to 68.5% and 61.3% of the levels of those released from the untreated control. The results confirm the hepatoprotective activities of zeaxanthins. Antihepatotoxic activities of zeaxanthins are comparable to that of silybin.

Acquired bilateral melanosis of the neck in perimenopausal women

BACKGROUND

Acquired bilateral patchy or mottled pigmentation of the neck has occasionally been observed.

OBJECTIVE

To investigate the clinical and histopathological characteristics of this pigmentation.

METHODS

Fourteen patients were included in the study. Patch and photopatch tests, and laboratory tests including serum hormonal evaluation were performed. Skin biopsies were performed on lesional skin and perilesional normal skin.

RESULTS

All the patients were women and all were perimenopausal. The lesions were characterized by bilateral, symmetrical, brown-to-grey patchy or mottled pigmentation on the lateral neck. There were positive photopatch results in some cases, but their relevance was doubtful. All laboratory findings were within the normal ranges. The histological findings showed marked accumulation of pigment in the dermis with perivascular lymphocytic infiltration. A significantly higher expression of melanogenesis-associated proteins and an increased number of melanocytes were observed in the epidermis of the lesional skin. The melanin-bearing cells in the dermis were stained with factor XIIIa or CD68, but the majority of these cells were identified as factor XIIIa+ dermal dendrocytes. Some brown pigments were mixed with light brown or golden brown pigment that was positive in iron staining.

CONCLUSIONS

These cases seem to represent a continuum of Riehl melanosis. However, the principal distribution of the pigmentation is a distinguishing feature. Any consistent predisposing factors were not established, but there may be a role for subclinical injury or inflammation as possible causative factors for development of the pigmentation.

Surgical outcomes and prognostic factors for ampulla of Vater cancer

BACKGROUND AND AIMS

The prognosis for patients with ampulla of Vater cancer is better than other periampullary cancers. The aim of the present study is to determine the clinicopathologic factors predictive of survival and recurrence in patients with ampulla of Vater cancer.

MATERIAL AND METHODS

From 1991 to 2008, we identified and reviewed 78 patients with ampulla of Vater cancer retrospectively. Clinicopathologic factors possibly influencing survival and recurrence were statistically analyzed.

RESULTS

Pancreaticoduodenectomy was performed in 68 patients and 2 patients underwent transduodenal ampullectomy. Hospital mortality was 2.6%. The 5-year survival rates following resection were 59.9%. Univariate analysis for overall survival revealed that total bilirubin greater than 5 mg/dl, ulcerative tumors, differentiation, and pancreatic invasion were significant prognostic factors. Recurrence occurred in 31 patients. Univariate analysis for disease-free survival revealed that total bilirubin greater than 5mg/dl, preoperative biliary drainage, tumor differentiation, and stage were statistically significant. Multivariate analysis revealed that tumor differentiation was an independent prognostic factor for recurrence. The presence of lymph node metastasis did not affect overall survival significantly in this study. However, two or more metastatic lymph nodes significantly affect disease-free survival.

CONCLUSIONS

Pancreaticoduodenectomy is a safe surgical procedure with acceptable long-term survival for ampulla of Vater cancer. Pancreaticoduodenectomy with lymph node dissection might control lymph node spread and enhance survival outcome.

The effects of cyclophosphamide and mycophenolate on end-stage renal disease and death of lupus nephritis

Debate continues about the optimal treatment modality of lupus nephritis (LN). We compared the efficacy and safety of intravenous cyclophosphamide (CYC) and mycophenolate mofetil (MMF) for LN treatment in Korea. After searching for systemic lupus erythematosus (SLE) patients diagnosed between 1998 and 2007 with the diagnostic code of ICD10, we selected the 71 patients who were treated with CYC or MMF without any other immunosuppressant except systemic steroid. Composite outcome was defined as progression to end-stage renal disease (ESRD) and/or all-cause mortality. The initial manifestations of the CYC group were more severe than those of the MMF group. The mean daily MMF dose was 980 ± 100 mg for 21.67 ± 18.25 months. The mean monthly dose per CYC pulse therapy was 850 ± 30 mg for 17.04 ± 13.15 months. The incidence of composite outcome was 5/20 (25%) in the MMF group and 4/51 (7.8%) in the CYC group. The relative risk (RR) for composite outcome in the CYC group was 0.249 (95% CI for RR: 0.067–0.934, p = 0.039) compared with the MMF group with Cox's hazard proportional analysis. In Kaplan–Meier analysis, the probability of composite outcome was lower in the CYC group than in the MMF group (Log rank test p-value = 0.026). The results of this retrospective study suggest that intravenous CYC therapy may be more efficacious in averting ESRD and death than MMF. These results need to be confirmed in a larger randomized controlled trial.

Immunohistochemical expression of matrix metalloproteinases in the granulomatous rosacea compared with the non-granulomatous rosacea

BACKGROUND

There is a granulomatous variant which is recognized in the rosacea spectrum. However, the pathogenesis of granuloma formation in rosacea has not been clearly demonstrated. Matrix metalloproteinases (MMPs) are required for recruitment of inflammatory cells and for tissue remodelling, making way for the development of well-organized granuloma.

OBJECTIVE

The aim of this study was to investigate the expression of transforming growth factor (TGF)-β, TGF-β type II receptor (TβRII), Tumour necrosis factor (TNF)-α, MMP-1, 2 and 9 in the granulomatous rosacea (GR) compared with the non-granulomatous rosacea (NGR) and test the hypothesis that the changes of these profiles in GR would be related with chronic ultraviolet radiation (UVR)-exposure.

METHODS

Facial skin samples were obtained from 20 patients with GR and NGR (control group). The sections were stained using haematoxylin and eosin, Verhoeff's elastic stain, and antibodies to TGF-β, TβRII, TNF-α, MMP-1, -2 and -9.

RESULTS

The amount of elastotic material was significantly increased in the dermis of GR lesions. Expression of TGF-β was significantly decreased in the epidermis of GR lesions compared with NGR lesions. In addition, the expression of MMP-9 was significantly increased in the dermis of GR lesions compared with NGR lesions, especially at the centre of the granuloma on a semi-quantitative analysis. MMP-2 expression was also increased in GR lesions, although the difference between the two groups was not statistically significant.

CONCLUSIONS

The results of this study suggest that the increased expression of MMPs in the dermis may participate in granuloma formation of GR in association with UVR.

Production of the antifungal compounds phenazine and pyrrolnitrin from Pseudomonas chlororaphis O6 is differentially regulated by glucose

AIMS

To determine whether glucose in growth medium affects secondary metabolite production and biocontrol efficacy of Pseudomonas chlororaphis O6.

METHODS AND RESULTS

The secondary metabolites pyrrolnitrin and phenazines antagonize phytopathogenic fungi. The expression of the prnA gene encoding tryptophan halogenase, the first step in pyrrolnitrin biosynthesis, required the stationary-phase sigma factor, RpoS. Mutations in rpoS and prnA in Ps. chlororaphis O6 eliminated antifungal activity against Rhizoctonia solani and Fusarium graminearum. Pyrrolnitrin production was reduced by glucose in growth media, whereas phenazine levels were increased. The efficacy of Ps. chlororaphis O6 in the biocontrol of tomato late blight was reduced by addition of glucose to the growth medium.

CONCLUSIONS

Regulation by glucose of pyrrolnitrin production influenced the efficacy of the biocontrol of tomato leaf blight.

SIGNIFICANCE AND IMPACT OF THE STUDY

The nutritional regulation of secondary metabolite production from a soil pseudomonad may account, at least in part, for the variability of biocontrol under field conditions.

Comparison of the clinical efficacy of NBUVB and NBUVB with benzoyl peroxide/clindamycin in progressive macular hypomelanosis

BACKGROUND

Progressive macular hypomelanosis (PMH) is a skin disorder characterized by multiple hypopigmented patches symmetrically distributed on the trunk. Several treatment modalities have been attempted; however, a standard treatment modality has not been agreed to.

OBJECTIVES

The aim of this study was to compare the effectiveness of antimicrobial therapy combined with narrow band ultraviolet B (NBUVB) with NBUVB monotherapy.

METHODS

A randomized left-right comparison study was conducted in a total of 10 patients. Patients received NBUVB therapy with daily application of antimicrobial gel on one side of the trunk (comb-NBUVB) and without it (mono-NBUVB) for 8 weeks. The clinical efficacy was determined by objective measurements using a colour analyser and subjective assessment by evaluating pictures taken with a digital camera at baseline, at the time of treatment cessation and 6 months after treatment.

RESULTS

Significant repigmentation was observed in all 10 patients during the 8 weeks of treatment. The mean difference in L values between lesional and non-lesional skin was reduced in the comb-NBUVB area (from 4.52 ± 1.65 to 0.94 ± 0.65), and in the mono-NBUVB area, (from 4.34 ± 1.39 to 1.18 ± 0.94). There was no significant difference between treated sites at both of the evaluation points in time. At 6 months after treatment, 7 of 10 patients completed the clinical trial, and some degree of clinical improvement remained in four of seven patients; recurrence occurred in the other patients.

CONCLUSIONS

Although recurrence occurred in some patients, NBUVB treatment appears to be a safe and useful modality for the treatment of PMH.

A feasibility study of magnetic separation of magnetic nanoparticle for forward osmosis

It was recently reported that a UK company has developed a naturally non-toxic magnetoferritin to act as a draw solute for drawing water in forward osmosis process. The gist of this technology is the utilization of the magnetic nanoparticle and high-gradient magnetic separation for draw solute separation and reuse. However, any demonstration on this technology has not been reported yet. In this study, a feasibility test of magnetic separation using magnetic nanoparticle was therefore performed to investigate the possibility of magnetic separation in water treatment such as desalination. Basically, a magnetic separation system consisted of a column packed with a bed of magnetically susceptible wools placed between the poles of electromagnet and Fe3O4 magnetic nanoparticle was used as a model nanoparticle. The effect of nanoparticle size to applied magnetic field in separation column was experimentally investigated and the magnetic field distribution in a magnet gap and the magnetic field gradient around stainless steel wool wire were analyzed through numerical simulation. The amount of magnetic nanoparticle captured in the separator column increased as the magnetic field strength and particle size increased. As a result, if magnetic separation is intended to be used for draw solute separation and reuse, both novel nanoparticle and large-scale high performance magnetic separator must be developed.

Acquired bilateral naevus of Ota-like macules: an immunohistological analysis of dermal melanogenic paracrine cytokine networks

BACKGROUND

Acquired bilateral naevus of Ota-like macules (ABNOM) is similar to melasma with regard to their clinical features, including female predominance, acquired onset, and predominant involvement of the malar area. The similar clinical features suggest the possibility of a shared pathogenesis. Dermal factors including vascularity and melanogenic paracrine networks such as the stem cell factor (SCF)/c-kit pathway have recently been suggested to play an important role in the pathogenesis of melasma. However, the role of dermal factors in ABNOM remains unknown.

OBJECTIVES

To provide a novel view on the pathogenesis of ABNOM, we studied the expression of melanogenic paracrine cytokines such as SCF/c-kit, and assessed dermal vascularity.

METHODS

Thirty-seven patients with ABNOM and 20 patients with melasma were enrolled in this study. Skin samples were obtained from lesional and perilesional normal skin. Immunohistochemistry was performed.

RESULTS

Solar elastosis was slightly more intense in the lesional skin of ABNOM. In contrast to dermal pigmentation and melanocytes, the amounts of epidermal pigmentation and melanocytes were not increased in the lesional skin of patients with ABNOM. The expression of dermal SCF and c-kit was increased; however, the expression of epidermal SCF and c-kit and dermal factor VIII-related antigen was not increased in the lesional skin of ABNOM.

CONCLUSIONS

These results suggest that the increased expression of the SCF/c-kit pathway between dermal fibroblasts and dermal melanocytes may play an important role in the pathogenesis of ABNOM.

Portable digital esophageal stethoscope system

Heart sound occurs when the heart contracts and expands. It provides information on myocardial contractility and blood vessels, which is not obtainable from ECG. For this reason, stethoscopy of heart sound in anesthesiology is a very crucial means for acquiring cardiac information and preventing intraoperative medical accidents, and it requires a system for precise objective measurement and analysis of heart sound and murmur. Thus, this study purposed to develop portable digital esophageal stethoscope (PDES) that can objectify and quantify heart sound and murmur. In this study, we designed PDES for precise measurement and analysis of heart sound and murmur data. Heart sound information obtained by inserting the sensor of the PDES into the patient's esophagus can be transmitted to a terminal or a PC and displayed on the screen The amplitude and waveform of heart sound are displayed using self-developed software Heart Sound 1.0. The results of experiment with the developed PDES showed that data on the amplitude and waveform of heart sound and murmur were produced stably in real-time. In addition, when heart sound was heard using a headphone, the sound was clear without external murmur. The PDES developed in this study, which complements the disadvantages of traditional esophageal stethoscope while preserving its advantages, could not only examine heart sound and murmur using an esophageal catheter but also display the amplitude and waveform of heart sound and murmur and measure the patient's body temperature. Accordingly, the developed PDES is expected to be useful in the continuous stethoscopy of heart sound during operation and to contribute to research on heart sound by providing heart sound data.