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Because of the poor prognosis and of oral mucosal melanoma, and patients' short survival, large, randomised, clinical studies are difficult. We have investigated its demographic characteristics and analysed the effect of treatment, resection margins, and metastases on survival. We recorded age, sex, site of primary tumour, and types of treatment, survival, and metastases in 74 patients treated at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Survival was analysed based on bony invasion, depth of invasion, and resection margins, and we found that it varied depending on the primary site (p=0.002), and declined with liver (p=0.001) or brain (p=0.033) metastases. The two-year survival according to the primary site was as follows: palate 85% (n=32), anterior maxillary gingiva 53% (n=13), mandible 58% (n=13), and posterior maxillary gingival 74% (n=10) and buccal mucosa 50% (n=4). The two-year survival was 34% (n=8) in patients with liver metastases and 23% (n=7) in patients with brain metastases. In cases of bony invasion (p=0.005), depth of invasion (p=0.042), unclear resection margin (p=0.023), or higher T stages (p=0.009), the survival declined considerably. Neck dissection did not affect survival (p=0.343). Survival of the patients given chemotherapy was significantly lower (p=0.013) and the two-year survival was 54.0%. The patients given radiotherapy showed no significant difference in survival compared with those not given radiotherapy (p=0.107). In conclusion, primary site, bony invasion, resection margins, depth of invasion and systemic metastases were critical to predict prognosis and selection of treatment of oral mucosal melanoma.

Although it has been established that diabetes increases susceptibility to infections, the role of insulin (INS) in the immune response is unknown. Here, we investigated the immunological function of INS. Proinsulin dimer (pINSd) was a potent immune stimulus that induced inflammatory cytokines, but mature INS was unable to induce an immune response. An affinity-purified rabbit polyclonal antibody raised against mature IL-1α recognized IL-1α and pINS but failed to detect mature INS and IL-1β. Analysis of the pINS sequence revealed the existence of an INS/IL-1α motif in the C-peptide of pINS. Surprisingly, the INS/IL-1α motif was recognized by monoclonal antibody raised against IL-1α. Deleting the INS/IL-1α motif in pINSd and IL-1α changed their activities. To investigate the pINSd receptor, the reconstitution of IL-1 receptor 1 (IL-1R1) in Wish cells restored pINSd activity that was reversed by an IL-1R antagonist. These data suggested that pINSd needs IL-1R1 for inflammatory cytokine induction. Mouse embryo fibroblast cells of IL-1R1-deficient mice further confirmed that pINSd promotes immune responses through IL-1R1.

Background. Alterations of erythrocyte membrane fatty acid (FA) composition play important roles in cellular function because they change the membrane microenvironment, including transmembrane receptors. The erythrocyte membrane oleic acid content is higher among patients with acute coronary syndrome and also in dialysis patients. However, available data are limited concerning erythrocyte membrane FA content in kidney transplant recipients (KTP). We sought to test the hypothesis that erythrocyte membrane FA content among KTP were different from those in dialysis patients. Methods. In this cross-sectional study, we recruited 35 hemodialysis, 33 peritoneal dialysis 49 KTP, and 33 normal control subjects (CTL). Their erythrocyte membrane FA content were measured by gas chromatography. Results. The mean ages of the enrolled dialysis patients, KTP, and CTL were 56.4 10.1, 48.9 10.4, and 49.5 8.3 years, respectively. Mean kidney transplant duration was 89.8 64.8 months and mean dialysis duration, 49.0 32.6 months. The intakes of vegetable lipid and vegetable protein including total calories were significantly increased among KTP versus dialysis patients. Total cholesterol (P .001) and high density lipoprotein cholesterol (HDL; P .001) levels were significantly higher and C-reactive protein was significantly lower among KTP compared with dialysis patients. The erythrocyte membrane content of palmitoleic acid (P .001) was significantly higher but oleic acid (P .001) significantly lower in KTP compared with dialysis patients. The erythrocyte membrane contents of arachidonic acid and docosahexaenoic acid were significantly higher, and linoleic acid and the omega-6 FA to omega-3 FA ratio (P .001) significantly lower in KTP compared with dialysis patients. The erythrocyte membrane content of oleic acid was independently associated with monounsaturated fatty acid (beta 0.771, P.001), eicosapentaeonic acid (beta0.244, P.010), and HDL (beta 0.139, P .049) in KTP. Conclusions. FA contents of erythrocyte membranes were significantly different in KTP compared with dialysis patients. These differences may have been associated with improved dietary intake and immunosuppression after kidney transplantation.

Aim To analyse the multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) findings in patients with atresia of the coronary sinus orifice (CSA). Materials and methods MDCT findings of 15 consecutive adult patients with CSAs were retrospectively analysed. The patients underwent contrast-enhanced electrocardiography-gated MDCT ( n = 13) or both CT and MRI ( n = 2). Results The mean size of the coronary sinus (CS) was 14.2 mm (range 5.5–24 mm) and 11 patients (73.3%) showed CS dilatation (diameter ≥12 mm). The mean length of the atretic CS segment was 2.9 mm (range 0–8 mm). Different forms of venous collateral pathways were observed in the CSA patients. Nine (60%) of the 15 CSA patients had communication between the right atrium (RA; n = 6) or LA ( n = 5) and CS via intraseptal veins; six patients (40%) had persistent left superior caval veins; communications were also observed between the CS and RA ( n = 4) or LA ( n = 4); two patients had collateral venous pathways between dilated cardiac veins with RA; two patients had unroofing of the CS as outlet channels. Nine patients (60%) had cardiac anomalies: coronary artery fistula to the pulmonary artery ( n = 6) or left ventricular base and CS ( n = 1), atrial septal defects ( n = 2), and a ventricular septal defect ( n = 1). Conclusion CSA patients have venous collateral pathways and a high incidence of associated cardiovascular anomalies such as coronary artery fistulae and atrial septal defects.

Chirp sub-bottom profiler (SBP) provides the high-resolution seismic sections with a decimeter scale vertical resolution and are used in various geophysical and geological studies. We conducted a pseudo 3D Chirp SBP survey to produce a 3D Chirp SBP seismic volume for an ancient wooden shipwreck in Mado, Taean Peninsula, Korea. The survey lines were designed to cross the shipwreck at 2-m intervals in the 30 × 250-m survey area. To improve the quality of Chirp SBP data, we used a newly constructed recording system that could record the raw data. An optimal processing sequence divided in 2D and 3D data processing was specifically designed to create a 3D Chirp SBP volume from a pseudo 3D Chirp SBP dataset. The final 3D Chirp SBP volume shows the amplitude variation of the shipwreck traces.

Protein phosphorylation is an important mechanism for the posttranslational modulation of ionotropic glutamate receptors and is subject to regulation by changing synaptic inputs. In this study, we investigated the regulation of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor GluR1 subunit phosphorylation by cocaine exposure in the rat dorsal striatum in vivo. We found that acute cocaine challenge followed by 6 days of repeated systemic injections of cocaine (20 mg/kg once daily) enhanced the sensitivity of the GluR1 subunit in its phosphorylation at serine 831 (Ser831) in the dorsal striatum. This enhancement of the sensitivity of Ser831 phosphorylation was reduced, at the receptor and ion channel level, by blocking (1) group I metabotropic glutamate receptors (mGluRs), (2) N-methyl-D-aspartate receptors, and (3) L-type voltage-operated Ca(2+) channels. Similar reduction of the enhancement was also induced, at the protein kinase level, by inhibiting (1) protein kinase C, (2) calcium/calmodulin-dependent protein kinases, and (3) c-Jun N-terminal kinases. In addition, inhibition of protein phosphatase 1/2A or calcineurin increased GluR1-Ser831 phosphorylation in the dorsal striatum of normal rats, whereas inhibition of these phosphatases did not further enhance the Ser831 phosphorylation in rats pretreated with 7 daily injections of cocaine. These data suggest that the phosphorylation of AMPA receptor GluR1 subunits at Ser831 is subject to upregulation by acute and repeated cocaine administration. Complex signaling integrations among glutamate receptors, Ca(2+) channels, protein kinases, and protein phosphatases participate in this upregulation.

Background This study compared the changes in plasma oxytocin, intraoperative hemodynamics and postoperative uterine activity in patients who underwent elective Shirodkar cerclage for cervical incompetence with general or spinal anesthesia. Methods Thirty-seven singleton pregnant patients were enrolled in this prospective, randomized, controlled comparison of general (n=17) and spinal anesthesia (n=20) for elective Shirodkar suture in the second trimester. Plasma oxytocin concentration was measured before, 1 h after, and 24 h after the procedure. Uterine activity was recorded by external tocography twice daily for 30 min over a three-day period. Results Plasma oxytocin concentration did not change significantly after cerclage in either group. There were no significant differences between the two groups at any time. None of the patients reported painful contractions during study period. Two (11.8%) and four patients (20.0%) in the general and spinal groups, respectively (NS), showed increased uterine activity but these symptoms disappeared without treatment. The systolic blood pressure in the spinal group was significantly lower after anesthesia compared with the baseline and was significantly lower than in the general group during the procedure. Conclusions Anesthetic method used for elective Shirodkar procedure did not affect the perioperative changes in plasma oxytocin nor postoperative uterine activity.

Background A randomised controlled trial (RCT) and its open label extension trial (OLE) demonstrated comparable pharmacokinetics (PK), efficacy and safety between CT-P10 and innovator rituximab (RTX) (including switched from RTX to CT-P10) up to 2 years in rheumatoid arthritis (RA) patients (NCT01534884 and NCT01873443). 1,2 Objectives To compare time to retreatment and confirm clinical similarity in efficacy and safety by the number of treatment courses in the RCT between CT-P10 and RTX in RA patients up to 2 years. Methods One hundred fifty three patients were randomised in 2:1 ratio and received up to 2 treatment courses of either CT-P10 or RTX in RCT, and they had a chance to receive up to 2 additional courses of CT-P10 in OLE. Retreatments were given based on disease activity. Post-hoc analyses using combined data obtained from the RCT and OLE studies were performed in 2 different groups according to the number of treatment courses in RCT as following; Group 1: patients who received 2 courses in RCT; Group 2: patients who received 1 course in RCT. Results A total of 82 patients (59 received CT-P10 and 23 received RTX) were in Group 1 and 20 (13 received CT-P10 and 7 received RTX) were in Group 2. Time to retreatment was similar between CT-P10 and RTX (including switched to CT-P10) in each group (Figure 1). DAS28 improvement at Week 24 of each course was similar between CT-P10 and RTX (including switched to CT-P10) in both groups (Table 1). Infusion related reactions by treatment course up to 2 years was similar between the CT-P10 and RTX groups and tended to decrease over time in line with RTX historical data. 3 Incidence rate of adverse event, serious adverse event and infection was comparable between CT-P10 and RTX groups. Conclusions The results of the post-hoc analyses demonstrated comparable duration of disease control between CT-P10 and RTX (including switched to CT-P10) with clinical similarity in efficacy for 2 years. The safety profile of CT-P10 was similar to that of RTX and in line with RTX historical data. References Yoo DH, et al. Arthritis Rheum 2013; 65 (Suppl10): S736 Yoo DH, et al. Arthritis Rheum 2015; 67 (Suppl10): 2449–245 van Vollenhoven RF, et al. EULAR 2013 (Madrid, Spain): Poster SAT0131 Disclosure of Interest W. Park Consultant for: CELLTRION,INC., D. H. Yoo Consultant for: CELLTRION,INC., C. H. Suh Consultant for: CELLTRION,INC., S. C. Shim Consultant for: CELLTRION,INC., S. J. Lee Employee of: CELLTRION,INC., S. Y. Lee Employee of: CELLTRION,INC., T. S. Kwon Employee of: CELLTRION,INC., S. M. Kim Employee of: CELLTRION,INC.

BACKGROUND AND PURPOSE: Detection of underlying tumor in patients with unknown-origin acute ICH may be difficult because acute hematoma may mask enhancement of tumor on postcontrast CT. We intended to investigate the clinical utility of DECT in differentiating tumor bleeding from pure ICH. MATERIALS AND METHODS: Using a dual-source CT scanner, we obtained TNC single-energy and postcontrast DECT scans for 56 patients with unknown-origin spontaneous ICH. From the 2 sets of postcontrast DECT images obtained with different tube energy, EA (equivalent to conventional postcontrast CT), VNC, color-coded iodine overlay, fusion images of iodine overlay and VNC images were produced. The diagnostic performances of fusion, EA, and combined EA and TNC images for detecting underlying tumors were compared. RESULTS: Of the 56 patients, 17 had primary or metastatic tumors (18 lesions) and 39 had nontumorous ICH. The sensitivities of fusion, EA, and combined EA and TNC images for detecting brain tumors were 94.4%, 61.1%, and 66.7%, respectively, and their specificities were 97.4%, 92.3%, and 89.7%, respectively. The areas under the ROC curves were 0.964, 0.786, and 0.842, respectively. Overall, the diagnostic performance of fusion images was significantly superior to EA (P = .006) and combined EA and TNC (P = .011) images. CONCLUSIONS: DECT may be useful in detecting underlying tumors in patients with unknown-origin ICH.

End-stage renal disease (ESRD) caused by diabetic nephropathy is increasing throughout the world. The survival of diabetic patients treated by transplantation has improved nowadays. Although recent studies have demonstrated preemptive kidney transplantation to be associated with better graft survival in CKD patients, the effect of pre-transplantation dialysis on graft outcomes among diabetic ESRD patients is unclear. This analysis summarized our experience with preemptive kidney transplantation in diabetic ESRD patients by retrospectively comparing 70 such patients transplanted between 1995 and 2009. These 70 patients were divided into two groups: 30 patients underwent preemptive and the other 40 transplantation after maintenance hemodialysis or peritoneal dialysis. We compared graft survivals, acute rejection episodes, postoperative complications, and delayed graft function rates. The 10-year patient survival of 100% in the preemptive group was similar to that of the nonpreemptive group (85%, P = .11). But the 10 year graft survival was higher among the preemptive than the nonpreemptive group (100% vs 75%, P = .02). Pre-transplantation modality did not affect graft survival. Therefore, preemptive kidney transplantation should be applied to eligible patients with diabetic ESRD.

Background Knee osteoarthritis (OA) is among the most common joint disease and is therefore a major social and health problem. Clinically, the knee OA is characterized by joint pain, tenderness, limitation of movement, and variable degrees of local inflammation. Objectives This study was undertaken to identify preoperative physical performance factors predictive of self-reported physical function and quality of life, and to propose a preoperative rehabilitation program to improve functional ability in patients scheduled for total knee arthroplasty. Methods A total of 55 older adults with end-stage knee OA awaiting a total knee arthroplasty (6 males and 49 females; average age 73.3±6.1 years) were recruited and tested preoperatively. Self-reported disease-specific physical function and self-reported pain were measured by using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Self-reported quality of life was measured by using EuroQOL five dimensions (EQ-5D) questionnaire. Physical performance tests included 6-minute walk test (6MWT), timed up and go (TUG) test, instrumental gait analysis for spatio-temporal parameters, and isometric knee flexor and extensor strength of the surgical and nonsurgical knees. Results In the bivariate analyses, the WOMAC function score had a significant positive correlation with the WOMAC pain score (r=0.62, p

Renal lupus vasculitis is a rare vascular lesion complicated with systemic lupus erythematosus (SLE). We report an unusual case of true renal lupus vasculitis with antineutrophil cytoplasmic antibodies (ANCA)-negative pauci-immune glomerulonephritis in a patient with SLE. A 32-year-old woman presenting with hematuria and overt proteinuria was admitted to the hospital. She had been diagnosed with SLE at 16 years of age and treated with prednisolone, hydroxychloroquine, and methotraxate. A kidney biopsy revealed 42 glomeruli with ischemic wrinkling, and segmental loop necrosis with fibrin deposition. Prominent inflammatory cell infiltration of interlobular arteries and afferent arterioles with severe necrosis was demonstrated. No electron- dense and immune deposits in the glomeruli were observed by immunofluorescent and electron microscopy; in contrast, those in the renal vascular wall showed a full-house pattern. Antiphospholipid antibodies and ANCA were negative. The patient was treated with monthly intravenous cyclophosphamide pulses and high dose steroid, and showed good response on further follow-up. (J Rheum Dis 2015;22:34-38)

Technology innovation is a major driver of rapidly rising healthcare costs (Newhouse 1992; Bodenheimer 2005; Laupacis and Evans 2005). Advanced imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) are now routinely employed in the diagnosis of common chronic conditions such as headaches and back pain. From 1993 to 2005, the annual numbers of CT and MRI scans performed in Ontario increased threefold and sixfold, respectively (Iron et al. 2003; Laupacis et al. 2005). The number of spinal MRIs, the second largest use of MRI after brain MRIs, has grown the fastest, from 10,523 in 1994 to 75,984 in 2005 (Laupacis et al. 2005), with back pain as its most frequent indication (You et al. 2008). While MRI offers the finest imaging, its use in spinal disorder diagnosis must be exercised with caution for two reasons. First, it is significantly costlier than plain X-ray imaging or CT. Second, for degenerative spinal disorders, MRI exhibits a high prevalence of non-correlative, incidental “abnormalities” in both symptomatic and asymptomatic individuals (Jensen et al. 1994; You et al. 2008), suggesting a lack of clinical effectiveness in its usage (Larson et al. 1980; Chou et al. 2009). This finding is in contrast to the use of MRI in headaches, for which negative imaging tests typically eliminate possibilities of life-threatening lesions. In the 2001 Ontario guidelines for clinical management of back pain, spinal MRI was recommended only for persisting back pain after clinical assessments and alternative imaging techniques have been performed (Deyo and Weinstein 2001; Institute for Clinical Systems Improvement 2010; Iron et al. 2004). Although a high level of physician compliance with these guidelines has been suggested (Iron et al. 2004), additional reports indicate otherwise (Staiger et al. 1999; Schers et al. 2000; Miller and Pinnington 2003; Cassidy et al. 2005; Kovacs et al. 2006; Dahan et al. 2008; Corbett et al. 2009; You et al. 2009), highlighting inconsistency in clinical practice. In this study, we investigated whether stronger adherence to the 2001 Ontario guidelines would reduce CT and MRI usage in spinal disorder diagnosis and be cost-effective from the perspective of the Ministry of Health. We designed and compared to usual care an alternative triage program in which patients were first diagnosed from their clinical assessments and plain X-rays prior to CT or MRI.

ackground and Objectives: Infraorbital low-out fracture (IOBF) is an uncomon midfacial trauma, and impairs eyeball unction and causes aesthetic problems. he extraoral approach can lead to some omplications such as scarring, ectropion, nd entropion. The intraoral approach, uch as a transantral approach, has advanages such as no visible scaring, it can be sed to simultaneously treat a zygomaticoaxillary complex fracture (ZMCF), and he procedure is relatively easy. ethods: IOBFs were reduced from the axillary sinus, and fixated internally sing miniplates and screws with/without edpor® (Porex, Newnan, GA, USA) ia a transantral approach. We used this echnique in 11 patients who had an infeior blow-out fracture. Patient’s records nd computed tomography scans were eviewed. esults: The mean age of the patients as 37 years (range, 15–68 years). The ean follow-up period was 9.8 months range, 1–24 months). Before the surgery, he patients had orbital symptoms: diplopia n 3 patients; enophthalmos in 4; and aze limitation in 3. All patients showed eriorbital swelling and ecchymosis. After urgery, none of the patients had diplopia, aze limitations, and enophthalmos. There ere no orbital symptoms or sinus sympoms due to an infection or allergic reaction fter surgery except in 1 patient. In 1 atient, maxillary sinusitis developed 4 months after surgery which subsided with antibiotic therapy after plate removal. Conclusion: We think this technique offers an easy approach, and produces reliable, satisfactory results in IOBF.