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Evaluate the treatment effects of maxillary protraction using palatal plates and compare them to those with conventional tooth-borne anchorage in growing patients with Class III malocclusion.Forty patients were divided into 2 groups according to the type of anchorage used: group 1 (n = 20; mean age, 10.5 ± 1.6 years; palatal plates) and group 2 (n = 20; mean age, 10.0 ± 1.2 years; tooth-borne appliances). Lateral cephalograms were taken before and after maxillary protraction. Skeletal, dental, and soft-tissue variables were measured. For statistical analysis, paired and independent t tests were performed.Group 1 showed maxilla advancement by 2.3 ± 1.0 mm compared with group 2 by 0.9 ± 0.6 mm, and group 2 indicated clockwise rotation of the mandible, but there was no such clockwise rotation in group 1 (P 0.001). Group 1 had a less lingual inclination of the mandibular incisors than group 2 (IMPA, -1.0 ± 3.8° vs -3.8 ± 2.8°; P 0.05). There was no difference in soft-tissue changes between the 2 groups.A facemask with palatal plate induced maxillary advancement with less mandibular clockwise rotation and dental movement than conventional tooth-borne anchorage. This modality can be used efficiently for maxillary protraction in growing patients with Class III malocclusion.

Background Retinoblastoma is an intraocular cancer of infancy and childhood, which has been treated with radiation therapy and chemotherapy. Radiation on growing patients can cause deterioration in maxillofacial growth and development that leads to severe skeletal discrepancies between the maxilla and mandible, and dental problems such as crossbite, openbite, and hypodontia. Case presentation We present the case of a 19-year-old Korean man with chewing disability and dentofacial deformities. He had undergone enucleation of the right eye and radiation therapy of the left eye due to retinoblastoma 100 days after birth. Subsequently, he received cancer therapy for the secondary nasopharyngeal cancer at the age of 11 years. He was diagnosed with severe skeletal deformity including sagittal, transverse, and vertical growth deficiency of the maxilla and midface, and with class III malocclusion, severe anterior and posterior crossbite, posterior openbite, multiple missing upper incisors, right premolars, and second molars, and impaction of the lower right second molars. To restore impaired functions and esthetics of the jaw and dentition, the orthodontic treatment combined with two jaw surgery was performed. At the end of surgical orthodontics, dental implants were placed for prosthetic treatment of missing teeth. Additional plastic surgery for zygoma elevation was done with calvarial bone graft followed by fat graft. Facial esthetics and occlusal functions of patient were favorably enhanced with the improvement of skeletal discrepancy and the rehabilitation of maxillary dentition by prosthetic work. At the 2-year follow-up, the skeletal and dental relationships and implant prosthetics were well maintained. Conclusion In an adult patient with dentofacial deformities caused by early cancer therapy in the head and neck area, interdisciplinary interventions including additional plastic surgery of zygoma depression and prosthetic work of missing teeth as well as surgical–orthodontic treatment could establish favorable facial esthetics and oral rehabilitation.

A new random conjugated terpolymer, coded as LGC-D054, was designed and synthesized. It is composed of N-alkylthieno[3,4-c]pyrrole-4,6-dione (TPD) as an electron-accepting unit, and benzodithiophene (BDT) and terthiophene as electron-donating units into the polymer backbone. The optical, electrochemical, and photovoltaic properties of the terpolymer were investigated. The polymer displayed an optical bandgap of 1.81 eV, with a highest occupied molecular orbital (HOMO) level of −5.25 eV. The bulk-heterojunction (BHJ) polymer solar cell (PSC) with the blend film based on LGC-D054:PC71BM exhibited a power conversion efficiency (PCE) of 4.46% with the short circuit current density (Jsc) of 8.71 mA/cm2 and a relatively high fill factor (FF) of 61.21%. After introducing 1,8-diiodooctane (DIO), BHJ film showed better phase separation and larger domain size. Furthermore, this optimized morphology promotes improved hole and electron mobilities, leading to a promising PCE of 5.08% with improved Jsc of 9.08 mA/cm2 and high FF of 66.02%.

In previous studies, PSCs based on polymers with an inward alkyl positioned DTBT unit showed poor power conversion efficiency mainly due to the greatly distorted polymer backbone structure caused by severe steric hindrance between the alkyl groups on the flanking thiophene of DTBT and the BT unit. In this study, PSCs based on polymers with an inward alkyl positioned DTBT unit are markedly improved by controlling the molecular weight and alkyl chain length. Two BDT-DTBTs and one BDT-BT polymers were synthesized by engineering alkylthienyl chains on BDT and by installing these with a short alkyl chain on the inward alkyl positioned DTBT. Extraordinary bathochromic shifts in the absorption maxima at 146 nm for PA and 165 nm for PB were observed going from solution to a solid film state, suggesting great differences in the polymer structures of the two states. Optical and electrochemical measurements were taken, and the HOMO levels of PA, PB, and PC were determined to be −5.76, −5.66, and −5.71 eV, respectively, indicating very low-lying HOMO energy levels. The optimized PSCs based on PA, PB, and PC exhibit power conversion efficiencies (PCEs) of 3.75%, 2.42%, and 2.30%, respectively, with Voc (0.77–0.86 V), Jsc (6.9–8.7 mA/cm2), and FF (38–52%). We believe that the highest PCE for the PSCs based on PA may be attributed to the high molecular weight and improved processability relative to those of PB and PC. A theoretical study suggests that the polymer backbones of PA and PB are highly distorted between the donor unit and the acceptor unit, by as much as 49°, possibly by the steric hindrance between BT and the inward positioned methyl group on the flanking thiophene. Therefore, the conjugations for the HOMO p-orbitals of PA and PB are highly localized throughout the backbone while the conjugations for the HOMO p-orbitals of PC are well delocalized. The AFM study revealed that DIO additive greatly changed the morphology of the polymer blend from an amorphous state into distinct nanoscale phase separated states, leading to a great improvement in PCEs. The XRD study revealed that all polymers are amorphous.

Surgically assisted orthodontics can be an effective treatment option to overcome advanced periodontal diseases, especially if retraction of the anterior teeth is required. A 46-year-old woman was treated with mandibular anterior segmental osteotomy (ASO) and prosthodontic restorations. Periodontally, hopeless teeth and an impacted canine were extracted in consideration of her age and treatment strategy. Mandibular ASO was performed for correction of anterior crossbite and lip protrusion. Treatment results were achieved in 22 months with combination of periodontal treatment and ASO-assisted orthodontic treatment. This report presents an effective surgically assisted orthodontic treatment option for correction of protrusion through mandibular ASO and premolar extraction in periodontally involved middle-aged adults.

A new random terpolymer, coded LGC-D013, based on N-alkylthieno[3,4-c]pyrrole-4,6-dione (TPD) as the acceptor and benzodithiophene (BDT) and terthiophene as the donor units, has been synthesized and characterized as a donor material in bulk-heterojunction (BHJ) organic photovoltaic (OPV) applications. The thermal, optical, and electrochemical properties of the LGC-D013 were characterized. The polymer has a deep highest occupied molecular orbital (HOMO) level of −5.56 eV and an optical band gap of 1.84 eV in film. The OPV based on LGC-D013:PC71BM blend film demonstrated a power conversion efficiency (PCE) of 6.09%, with a relatively high fill factor (FF) of 72.55%. After 1,8-diiodooctane (DIO) treatment with a 3% volume ratio, the short circuit current density (Jsc) was improved from 9.48 to 11.29 mA cm−2, and FF was improved from 72.55 to 73.13%, resulting in PCE improvement from 6.09 to 7.22%. The BHJ OPV using LGC-D013 as the donor polymer based on TPD and BDT with terthiophene showed an improved fill factor as high as 72%, which is higher than those of conventional TPD–BDT based polymers.

In this note we describe some classes of rings in relation to Abelian property of factorizations by nilradicals and Jacobson radical. The ring theoretical structures are investigated for various sorts of such factor rings which occur in the process.

Purpose Most reports on the surgery-first approach in skeletal Class III malocclusion have focused on the skeletal changes. The present study evaluated the soft tissue changes around the lips over time after mandibular setback surgery (MS) with minimal orthodontics (MO) using 3-dimensional (3D) stereophotogrammetry. Materials and Methods We performed a retrospective study of patients with mandibular prognathism who had undergone MS-MO. Lateral cephalograms and 3D photographs were taken before (T0) and 1 (T1) and 6 months (T2) after surgery and were superimposed. A paired t test, independent t test, and simple linear regression analysis were used to evaluate the hard and soft tissue changes and their correlation. Results The sample included 15 patients (7 males and 8 females). The soft tissue landmarks on the X-axis (left–right) showed no significant positional changes. The landmarks of the lips and oral commissure on the Y-axis (vertical) moved downward until T2; however, most of these changes did not differ significantly over time (T1 compared with T0 and T2 compared with T0). The landmarks in the lower lip, oral commissure, and soft tissue chin on the Z-axis (anterior–posterior) showed posterior movement at T1 and T2. In contrast, the lower lip (labiale inferius, 1.67 mm) and soft tissue chin (soft tissue B point, 1.28 mm; soft tissue pogonion, 1.61 mm) moved significantly forward from T1 to T2, but had no correlation with the anterior relapse of the mandible. Conclusions Protrusion of the lower lip and soft tissue chin with forward and upward relapse of the mandible during postoperative orthodontics was observed. The results from the present study suggest that 3D stereophotogrammetry can be useful for evaluating the perioral soft tissue changes over time in orthognathic surgery patients.

Imperfection originating from the ionic nature of organic inorganic hybrid perovskite (OIHP) is a major factor that degrades perovskite solar cells (PSCs) performance, and mitigating or removing it is essential for the implementation of high-performance PSCs. In this work, 2-hydroxyethyl acrylate (HEA), having both effective C O and O–H functional groups, is introduced as a functional additive that suppress imperfections by to control the crystallization process and passivate them at the same time, and the role of each function groups have been systematically investigated. We have found that O–H functional groups of HEA strongly interacts with organic cations (i.e., MABr, FAI) to form more stable organic cation-HEA complex selectively, delaying the crystallization process of perovskite. As a result, HEA improves crystallinity and grain size of perovskite and reduces charge trapping density by passivation and/or suppression of defect states. HEA raises average cell-efficiency from 17.37% to 19.01% and the maximum efficiency is reached to 21.01% for the inverted planar PSC. In addition, large-area (1.08 cm2) PSCs show an excellent efficiency of 20.40%, which is the highest efficiency in large-area inverted planar PSCs to date. PSCs with HEA also show long-term stability and better moisture resistance capabilities in ambient air conditions.

Proliferative and migratory abilities of fibroblasts are essential for wound healing at the skin surface. Cytoplasmic linker-associated protein-2 (CLASP2) was originally found to interact with cytoplasmic linker protein (CLIP)-170. CLASP2 plays an important role in microtubule stabilization and the microtubule-stabilizing activity of CLASP2 depends on its interactions with end binding (EB)-1 and CLIP-170. Although the microtubule-stabilizing role of CLASP2 is well established, the effects of CLASP2 on the migration and proliferation of fibroblasts remain unclear in the context of wound healing. Therefore, we tested the utilization of CLASP2 as a directly applied protein drug to improve wound healing by promoting the migration of effector cells, including skin fibroblasts, to the site of repair or injury using an in vivo excisional wound mouse model and in vitro Hs27 skin fibroblast model. Epidermal growth factor, which is a recognized contributor to cell proliferation and migration, was used as positive control. In vitro and in vivo, CLASP2 treatment significantly enhanced cell migration and accelerated wound closure. Furthermore, in vivo, the CLASP2-treated animal group displayed enhanced epidermal repair and collagen deposition. Next, we studied the mechanism of CLASP2 for wound healing. Increasing the abundance of intracellular free CLASP2 in skin fibroblasts by supplying exogenous CLASP2 seemed to stabilize microtubules through an interaction between CLASP2 and CLIP-170, as well as EB1. Exogenous CLASP2 also showed direct binding with IQGAP1, increasing both cyclic adenosine monophosphate activity and phosphorylation of glycogen synthase kinase 3β, which in turn reinstated the binding between free CLASP2 and IQGAP1. In summary, exogenous CLASP2 increased Hs27 skin fibroblast migration by interacting with IQGAP1 and other cytoskeletal linker proteins, such as CLIP-170 and EB1. Our results strongly suggest that CLASP2 can be developed in wound healing drugs for skin repair and/or regenerating cosmetic products.

Two random copolymers based on (2,5-difluorophenylene)dithiophene and dialkoxybenzothiadiazole with benzodithiophene (P1) or thiophene (P2) as the third conjugated bridge having sulfur and fluorine (S⋯F) and/or oxygen (S⋯O) non-covalent intramolecular interaction are synthesized and characterized. In spite of a molecular weight difference over three times between both polymers, P1 and P2 possess similar solubility in organic solvents and thermal stability (Td ∼ 320 °C), which means probably due to that P1 with bulky alkylthiophene substituted benzodithiophene as a third conjugated bridge has less non-covalent intramolecular interaction than that of P2 with thiophene as a bridge. Both polymers were used as electron donors in bulk heterojunction organic photovoltaics (BHJ OPV) with PC71BM as an acceptor. From the photovoltaic measurements it was revealed that P2 shows higher power conversion efficiency (PCE) of up to 6.82% than that of P1 (2.44%). After 1,8-diiodooctane (DIO) treatments as a processing additive, the P1 and P2 devices show a significantly improved PCE of 5.95% for P1 and 7.71% for P2. The surface morphology analysis of the blend films using the atomic force microscope (AFM) reveals that the P1:PC71BM film shows macrophase separation, while the P2 film has a smooth morphology. After DIO treatments, the morphology of both polymer blend films is improved with better bi-continuous nanoscale networks. Charge carrier mobilities through the space charge limited current (SCLC) method demonstrate that P2 with the thiophene bridge has higher charge carrier mobilities than P1. In particular, an inverted structured BHJ OPV with P2 exhibits a PCE of 8.50%, which is the highest PCE reported in the literature regarding random copolymers.

The purpose of this case report is to describe an interdisciplinary approach for a 51-year-old male who underwent multiple facial fractures including bilateral condyle fractures. The patient underwent emergency surgery, which included open reduction of the maxilla and mandibular symphysis and closed reduction of the bilateral condyle fractures. Although the patient recovered a comfortable range of mouth opening and alleviation of the temporomandibular joint (TMJ) symptoms after surgery, he suffered from a large anterior-posterior discrepancy due to less stability on the condyle-fossa relationships and from open bite with contacts only on both second molars and right second premolars. In this case, first, to increase the occlusal contact, comprehensive orthodontic treatment was completed. Second, occlusal equilibration was selectively performed to relieve the interferences and establish a stable range of mandibular movement without any changes in the vertical dimension. Third, both the upper central incisors and left lateral incisor were minimally restored with splinted and single zirconia crowns, which had modified lingual contours to provide adequate anterior guidance permitting the anterior-posterior discrepancy of the posterior teeth during protrusion. This conservative interdisciplinary treatment, including open and closed reduction, orthodontic treatment, occlusal adjustment, and minimal prosthetic restorations, resulted in a stable mandibular position and recovery of mastication function.

The aim of this study was to compare the efficacy of immunosuppressive therapy alone with that of combination therapy involving immunosuppressants and anticoagulation for the treatment of venous thrombosis in Behcet's disease (BD). A retrospective analysis was made of 37 patients with venous thrombosis in BD. BD patients with venous thrombosis were divided into three groups: one group (N = 16) received immunosuppressive therapy alone, another group (N = 17) received immunosuppressant and anticoagulation combination therapy, and the third group (N = 4) received anticoagulation therapy only. Clinical and laboratory parameters and the recurrence of venous thrombosis were assessed. Venous thrombosis in BD appeared to have a more diffuse pattern than idiopathic type and a predilection for lower limbs. The most commonly involved sites were the superficial and common femoral veins. Recurrence of venous thrombosis occurred in two cases in the immunosuppressant group (12.5%), one case in the combination therapy group (5.9%), and three cases in the anticoagulant group (75%). No significant difference was found between recurrence in the immunosuppressant and combination therapy groups. Acute phase reactants were elevated in all six patients at the time of venous thrombosis recurrence. Our study suggests that immunosuppressive therapy is essential and that anticoagulation therapy might not be required for the treatment of deep venous thrombosis associated with BD.

Purpose Most studies on the surgery-first approach focused on skeletal relapse compared with conventional surgery. The objective of this study was to compare the stability of skeletal Class III patients with 2 different vertical facial types after mandibular setback surgery (MS) with minimal orthodontic preparation (MO). Materials and Methods In this retrospective study, the patients were recruited from a population that had undergone MS. Consecutive patients were selected based on the following inclusion criteria: skeletal Class III malocclusion with mandibular prognathism, MO without extraction for less than 6 months, and sagittal split ramus osteotomy. The vertical facial types of the patients were classified based on the Frankfort mandibular-plane angle (FMA). Lateral cephalograms were taken at the presurgical stage, at 1 month after surgery (T1), and at the debonding stage (T2). To evaluate surgical changes (T1 – presurgical stage) and relapse (T2 – T1), the linear, angular, and dental measurements were analyzed using a paired t test and an independent t test. Results The 26 patients were divided into 2 groups: normal-angle group (n = 14; mean FMA, 23.58°) and high-angle (HA) group (n = 12; mean FMA, 30.26°). From T1 to T2, the normal-angle and HA groups showed significant forward and counterclockwise rotation of the mandible (distance between pogonion and perpendicular line to Frankfort horizontal plane from sella, 1.71 mm and 1.51 mm, respectively; distance between menton and perpendicular line to Frankfort horizontal plane from sella, 1.91 mm and 1.60 mm, respectively; angle between articulare-menton line and Frankfort horizontal plane, −0.55° and −0.89°, respectively). The HA group showed a significant upward movement of the mandible (distance from Frankfort horizontal plane to pogonion, −1.13 mm; distance from Frankfort horizontal plane to menton, −0.78 mm). However, there was no significant difference in the skeletal-dental changes between the 2 groups from T1 to T2. Conclusions The vertical facial types of Class III patients with similar prognathic mandible and dental patterns may not cause any differences in the relapse pattern after MS-MO.

Congenital heart defect (CHD) is common in infants with Down syndrome (DS), which is the principle cause of mortality. However, there is no data available for the frequency and types of CHD in infants with DS in Korea. We investigated the frequency of CHD in infants with DS in Korea. After the survey on birth defects was conducted throughout the country, the prevalence of CHD in DS in 2005-2006 was calculated. This study was conducted based on the medical insurance claims database of the National Health Insurance Corporation. The number of total births in Korea was 888,263 in 2005-2006; of them, 25,975 cases of birth defects were identified. The prevalence of DS was 4.4 per 10,000 total births, accounting for 1.5% of all birth defects. Of the 394 infants with DS, 224 (56.9%) had a CHD. Atrial septal defect was the most common defect accounting for 30.5% of DS followed by ventricular septal defect (19.3%), patent duct arteriosus (17.5%), and atrioventricular septal defect (9.4%). Our study will be helpful to demonstrate the current status of DS and to identify the distribution of CHD in infants with DS in Korea.

Resume Les symptomes rhumatologiques constituent le principal point d'appel chez une majorite de patients atteints de lupus erythemateux systemique (LES). Mais la survenue d'une neoproliferation osseuse, sous la forme d'appositions periostees, est exceptionnelle au cours du LES. Nous rapportons ici un cas d'appositions periostees au cours du LES. Il s'agissait d'une femme âgee de 31 ans ayant presente des douleurs des genoux. Les radiographies mettaient en evidence des appositions periostees sur chacun des femurs et des tibias, et autour de la metaphyse distale du tibia droit. Les proliferations du perioste peuvent etre la consequence de lesions osseuses benignes ou malignes ainsi que d'infections. Chez notre patiente, nous n'avons pas retrouve d'autre etiologie a la proliferation periostee, apres une evaluation exhaustive. Au cours du LES, la survenue d'appositions periostees pourrait etre due a des phenomenes d'inflammation vasculaire. Aucune nouvelle observation de cette association n'avait ete publiee depuis 1990 et aucune n'avait jamais ete rapportee en Coree.

Illumina microarray was used to identify differentially expressed genes in three epithelial ovarian cancer (EOC) cells. To validate the microarray data, mRNA and protein level of glucose transporter-1 (GLUT-1) was examined. GLUT-1 had an EOC/normal cells ratio of 5.51 based on microarray. Real-time PCR and immunohistochemistry demonstrated that GLUT-1 expression was significantly increased in EOC (p = .029 and p < .001, respectively). On survival analysis, GLUT-1 overexpression (HR = 4.80, p = .027) and lymph node metastases (HR = 8.35, p = .016) conferred a significantly worse overall survival. In conclusion, GLUT-1 expression is remarkably upregulated in EOC and predicts a poor overall survival.

Purpose Most reports on the surgery-first approach in patients with skeletal Class III malocclusion have focused on skeletal changes and treatment efficacy. This study sought to evaluate the association between the transverse changes of arch dimension and postsurgical relapse of the mandible after mandibular setback surgery (MS) with minimal orthodontic preparation (MO) without extractions (N). Materials and Methods This was a retrospective cohort study. The sample consisted of patients with skeletal Class III malocclusion who underwent MS-MO/N. Primary outcome variables were horizontal, vertical, and angular changes of the mandibular position (mandibular relapse). Predictor variables included changes in the transverse width of the upper and lower arches. Lateral cephalograms and study models were obtained and measured before (T0) and 1 month (T1), 3 months (T2), and 6 months (T3) after surgery. Descriptive, paired t test, repeated measures analysis of variance, and a generalized estimating equation with Bonferroni correction were computed. Results The sample consisted of 12 patients (7 female and 5 male; mean age, 19.83 ± 2.37 yr). Significant anterior and superior movements and counterclockwise rotation of the mandible were noted from T1 to T3. Despite dental decompensation from T1 to T3, there were no significant postsurgical changes in arch width. In addition, there was no correlation between the forward and upward movements of the mandible and changes of arch width. However, the counterclockwise rotation of the mandible was correlated with the changes in the upper inter–first premolar width (UIP1W) and lower inter–first molar width (LIM1W) over time. Conclusion The changes in arch width had no association with horizontal and vertical relapses of the mandible. Only changes in UIP1W and LIM1W showed an association with angular relapse of the mandible.

Objectives The aim of this study is to measure α-defensin-1 expression in the peripheral blood of patients with Behcet's disease (BD) and healthy control (HC) and to assess the association between α-defensin-1 expression and clinical features of BD. Methods Our patients fulfilled the diagnostic criteria of the international BD study group. ELISA and real-time PCR were performed to measure α-defensin-1 protein level in the sera and α-defensin-1 mRNA level in peripheral blood mononuclear cells (PBMC), respectively. Results The α-defensin-1 mRNA expression was significantly higher in BD patients ( n = 59) than HC ( n = 34) (0.49 ± 0.10 vs. 0.19 ± 0.45, P = 0.03). The level of α-defensin-1 mRNA and protein was significantly higher in active patients than inactive patients ( n = 15, 0.91 ± 0.28 vs. n = 44, 0.35 ± 0.09, P n = 21, 7.50 ± 2.14 ng/ml vs. n = 50, 3.32 ± 0.96 ng/ml, P = 0.001, respectively). The level of α-defensin-1 mRNA was significant higher in patients with arthritis ( n = 20) than those without arthritis ( n = 39). Conclusion α-defensin-1 mRNA and protein levels are significantly increased in BD patients, especially in active BD patients. Furthermore, α-defensin-1 mRNA is over-expressed in the PBMC of BD patients with arthritis. The present study suggests that α-defensin-1 may be involved in the pathogenesis of BD and can be used as valuable biologic marker for estimation of disease activity in BD.

As a measure of healthcare cost containment, the total number of vials of entanercept (25 mg) that can be prescribed for patients with inflammatory arthritis is restricted in Korea. Consequently, attempts to extend the dosing interval while maintaining the efficacy have not been an uncommon clinical practice. The aim of this study was to determine if extended doing interval of etanercept can be effective in patients with ankylosing spondylitis (AS). We performed a retrospective analysis using medical records at a single tertiary hospital. One hundred and nine patients with AS and 79 patients with rheumatoid arthritis (RA) started on etanercept between November 2004 and November 2009 were identified. Etanercept (25 mg) was started with twice-weekly dosing schedule. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive protein (CRP), and etanercept dosing interval for AS patients at 0, 3, 9, 15, 21 months were reviewed. Dosing interval for RA patients was analyzed for comparison. In AS, mean dosing interval was 4.7 +/- 2.1 days at 3 months and was increased to 12.1 +/- 7.0 days at 21 months. Despite the progressive increase in the dosing interval, the mean BASDAI declined rapidly at 3 months, and continued to decrease over 21 months. Mean CRP declined after 3 months of therapy and remained low thereafter. In RA, mean dosing interval was 4.0 +/- 1.2 days at 3 months and 5.1 +/- 1.8 days at 21 months. In conclusion, in AS, extended dosing of etanercept can be effective without compromising clinical and laboratory markers of disease activity as measured by BASDAI and CRP, respectively. Tapering of etanercept was less accommodating in RA when compared to AS.

We sought to evaluate the frequency of cervical spine (C-spine) involvement, and associated risk factors for this disorder and its progression in Korean patients with rheumatoid arthritis (RA). From 1995 to 2008, we recruited patients with RA attending the rheumatology clinic of a single tertiary care hospital, and evaluated 1,120 of the patients who had neck pain for C-spine involvement. A diagnosis of C-spine involvement was made in 28.6% of patients evaluated, and within this group, anterior atlantoaxial subluxation (AAS) and subaxial subluxation were found in 89.7 and 15%, respectively. Of the 1,120 patients, 570 patients were followed for more than 3 years. Comparing the clinical characteristics of 193 patients with C-spine involvement and 377 patients without C-spine involvement, we found the associations with female gender, RA diagnosis at or before age 45, erosive changes in hand or foot radiographs, C-reactive protein levels and erythrocyte sedimentation rates at the time of first visit, and combination disease-modifying anti-rheumatic drug (DMARD) therapy. We found using logistic regression analysis that significant predictors of C-spine involvement included erosion in hand or foot radiographs (OR = 2.22, p = 0.001) and RA diagnosis at or before age 45 (OR = 2.26, p

Hypoxia-inducible factor-1alpha (HIF-1alpha) is a master regulator in the cellular response to hypoxic conditions, and rheumatoid synovial tissue is known to exist under hypoxic conditions. Therefore, this study was conducted to determine the contribution of HIF-1alpha to hypoxia-induced MMP and cytokine production in fibroblast-like synoviocytes (FLS).RA FLS were transfected with either a plasmid that expresses HIF-1alpha or an empty vector as a control, and then cultured under normoxia (21% O(2)). Also, FLS were transfected with either HIF-1alpha small interfering RNA (siRNA) or control siRNA, and cultured under hypoxic conditions (1% O(2)). Following transfection, the amounts of MMP and cytokine mRNAs and HIF-1alpha protein were examined using real-time RT-PCR and western blotting, respectively.The expression of HIF-1alpha, MMP-1, MMP-3, IL-6 and IL-8 was markedly enhanced in FLS that were cultured under hypoxia. We confirmed that transient transfection of HIF-1alpha overexpressing vector or siRNA had occurred using western blotting, and in vitro studies conducted using FLS transfected with HIF-1alpha overexpression vector showed that they had significantly increased MMP-1, MMP-3 and IL-8 expression levels. Further, hypoxia-induced MMP-3 expression was significantly attenuated by knock-down of HIF-1alpha, whereas hypoxia-induced IL-8 or MMP-1 expression was not significantly repressed by HIF-1alpha siRNA.Hypoxia-induced MMP-3 expression is exclusively regulated by HIF-1alpha, and hypoxia-induced MMP-1 or IL-8 expression appears to have salvage pathways other than the HIF-1alpha pathway. Together, these data provide new insight regarding the mechanism by which hypoxia participates in joint inflammation and destruction in RA.

Musculoskeletal complaints are the most common presenting symptoms in most of the patients with systemic lupus erythematosus (SLE). However, periosteal new bone formation is an extraordinarily rare condition in SLE. We report a case of periosteal reaction in SLE. A 31-year-old woman with SLE presented with both knee pain. Radiographs revealed periosteal reactions in both femur and tibia and around the metaphysis of the right distal tibia. Periosteal reaction can be caused by benign or malignant lesions and infection. We cannot find any other cause of periosteal reaction in our case after thorough evaluations. Periosteal reaction in SLE might be associated with inflammatory vascular changes. This is the first report of periosteal reaction in SLE after the 1990s description and the first report in Korea.

Objective The aim of this study was to investigate the prevalence of orofacial clefts and identify the characteristics of other birth defects associated with orofacial clefts in Korea. Methods This study used data from the Congenital Anomaly Survey conducted by the Korea Institute for Health and Social Affairs. The survey was conducted on birth defects documented during 2005 to 2006 in 2,348 medical institutes in Korea. This study was performed using data from medical insurance claims of the National Health Insurance Corporation. The prevalence of orofacial clefts was defined as the number of cases per 10,000 live births. Results Among the 883,184 live births, 25,335 infants had birth defects, which included 980 infants with orofacial clefts. The prevalence of total orofacial clefts in the total live births was 11.09 per 10,000, accounting for 3.9% of all birth defects. The most common orofacial cleft was cleft palate only (n=492), followed by cleft lip only (n=245) and cleft lip with cleft palate (n=243), with prevalence rates of 5.57, 2.77, 2.75 per 10,000 live births, respectively. While malformations of the circulatory system; digestive system; eyes, ears, face, and neck; and musculoskeletal system were most frequently encountered among infants with a cleft lip with or without a cleft palate, anomalies of most organ systems were notably observed among infants with cleft palate only. Conclusion The prevalence of orofacial clefts in Korea was similar or slightly lower than that of other countries. This study informs present status of orofacial clefts and gives baseline data to lay the foundation stone for Korea's registry system of orofacial clefts.

Adult-onset Still`s disease (AOSD) is a systemic inflammatory disorder with variable clinical features. The interleukin (IL)-1 receptor antagonist anakinra has been proposed as an alternative effective treatment in refractory AOSD. We report, for the first time in Korea, two cases of refractory AOSD in which anakinra treatment produced a clinical response. The first patient had frequent clinical flare-ups with fever, sore throat, myalgia, and pleuritic chest pain despite treatment with methotrexate and etanercept. In the second patient, treatments with various immunosuppressive agents failed to control the disease activity. Treatment with anakinra 100 mg/day was initiated in both cases. A complete clinical remission and improvement in the laboratory parameters were observed. The steroid dose was tapered without further clinical flare-ups. Anakinra appears to be an effective alternative treatment modality in patients with AOSD refractory to conventional disease-modifying anti-rheumatic drugs and corticosteroid therapy. (Korean J Med 2012;82:520-524)

Ovarian vein thrombosis (OVT) is a rare cause of acute abdominal pain, and it affects approximately 1 in 2,000 deliveries or abortion [1]. However, this diagnosis should be considered not only in postpartum patients but also in women with pelvic infl ammatory disease (PID), with malignancy, who went through recent abdominal surgery, or has known hypercoagulable state [2]. Common symptoms of OVT are fever, nausea, vomiting, chills, lower abdominal pain, tachycardia, and fl pain. The clinical manifestations are variable from asymptomatic and dull abdominal pain to sepsis, pulmonary embolism and life threatening events. The complications of OVT can be significant, so careful diagnosis, which is based on computed tomography (CT), color Doppler ultrasonography and magnetic resonance imaging (MRI), is important [3]. Differential diagnosis must be included appendicitis, peritonitis, adnexal torsion, tubo-ovarian abscess, ectopic pregnancy, intussusception, and pyelonephritis [1]. We report a case of a patient presenting with OVT which is accompanied with PID, and review the diagnostic and therapeutic options for this disease.

Leflunomide is a disease-modifying antirheumatic drug that has been available in Korea since 2003. Leflunomide induced interstitial pneumonitis has been reported as an adverse effect in other countries but not in Korea. A 57-year-old woman was treated with leflunomide since she had been resistant to methotrexate, hydroxychloroquine and sulfasalazine. She developed high fever, dyspnea, and non-productive cough 3 months after the administration of leflunomide. She was diagnosed leflunomide-induced interstitial pneumonitis based on history, physical, laboratory, radiologic and pathologic findings. The patient was treated by prednisolone 1 mg/kg/day with cholestyramine 24 g/day, resulting in dramatic improvement. Here we report a case of leflunomide induced pneumonitis treated successfully with high dose steroid.