Search

Microbiome research has been on the rise recently for a more in-depth understanding of gout. Meanwhile, there is a need to understand the gut microbiome related to uric acid-lowering drug resistance. In this study, 16S rRNA gene-based microbiota analysis was performed for a total of 65 stool samples from 17 healthy controls and 48 febuxostat-treated gout patients (including 28 controlled subjects with decreased uric acid levels and 20 uncontrolled subjects with non-reduced uric acid levels). Alpha diversity of bacterial community decreased in the healthy control, controlled, and uncontrolled groups. In the case of beta diversity, the bacterial community was significantly different among groups (healthy control, controlled, and uncontrolled groups). Taxonomic biomarker analysis revealed the increased population of g-Bifidobacterium in healthy controls and g-Prevotella in uncontrolled patients. PCR further confirmed this result at the species level. Additionally, functional metagenomics predictions led to the exploration of various functional biomarkers, including purine metabolism. The results of this study can serve as a basis for developing potential new strategies for diagnosing and treating gout from microbiome prospects.

BACKGROUND Sjogren’s syndrome (SS), which affect salivary gland function, is an autoimmune disease. SS may involve extraglandular organs. Approximately 10 to 20 percent of SS patients have clinically significant lung disease, but presentation of pulmonary amylodosis is extremly rare. The incidence of benign monoclonal gammopathy in SS patients is high, but multiple myeloma is rare. No case involving the simultaneous occurrence of two rare diseases, pulmonary amyloidosis and multiple myeloma, in the same patient with SS has been reported so far. CASE SUMMARY A 41-year-old male patient was referred to our hematology department due to incidentally detected gastric plasmacytoma. He had been diagnosed with SS four years earlier. Multiple miliary nodules, ground glass opacity in both lung fields, and enlargement of both inguinal lymph nodes was observed on chest and abdomen computer tomography. Based on the pathological findings of lung and lymph node biopsied specimens, the patient was diagnosed with pulmonary amyloidosis and multiple myeloma. Pulmonary amyloidosis and multiple myeloma associated with SS has rarely been reported. CONCLUSION This is an extremely rare case of simultaneous pulmonary amyloidosis and multiple myeloma in the same patient with SS.

Abeliophyllum distichum Nakai is a deciduous shrub that belongs to Oleaceae Abeliophyllum and grows only in Korea. In this study, the antioxidative activity, cytotoxicity, anti-aging activity, and levels of acteoside and isoacteoside were compared between non-fermented and fermented (using Lactobacillus plantarum and Lactobacillus brevis) extracts of A. distichum Nakai. The cytotoxicity of these extracts, along with their ability to inhibit elastase activity and Matrix metalloproteinase-1 (MMP-1) expression, and their ability to promote type I procollagen synthesis were investigated in human dermal fibroblasts cells. These tests revealed that the fermented extract possessed higher antioxidant and anti-aging activities compared with the non-fermented extract. The levels of acteoside and isoacteoside were about 1.25 and 1.05 times higher in the fermented extract than in the non-fermented extract. It was speculated that they were converted from acteoside glucosides and isoacteoside glucosides via bioconversion by the fermentation strains. Together, these findings indicate that extracts of A. distichum Nakai show good potential as antioxidative and anti-aging cosmetic materials. Key words: Abeliophyllum distichum Nakai, Lactobacillus plantarum, Lactobacillus brevis, fermentation, antioxidative activity, anti-aging activity.

The antioxidant, cytotoxic and antimicrobial effects of fermented and non-fermented extracts of ‘the Korean shrub’ Dendropanax morbifera and sweet potato were compared to assess the potential utility of these species in the development of health-oriented food. Non-fermented extract (NFDSE) was obtained from the leaves and branches of D. morbifera and the bodies of sweet potato using distilled water. The fermented extract (FDSE) was prepared by inoculating the above-obtained extracts with Lactobacillus plantarum and Lactobacillus brevis. The extracts of the two species combined D. morbifera and sweet potato exhibited substantial antioxidant activity. Moreover, NFDSE at 24 h exerted more antioxidant effects than FDSE (72.57% vs. 71.08%, respectively) at a concentration of 100 mg/ml. Comparison of the effects of the non-fermented and fermented extracts on HaCaT keratinocyte cell viability revealed that FDSE had a slightly higher cytotoxicity than NFDSE (94.8% vs. 102.7% viability, respectively) at a concentration of 500 i­g/ml. It was further found that NFDSE and FDSE had the strongest antimicrobial effects against Staphylococcus aureus ATCC 25923 and Staphylococcus epidermidis (a Gram-positive coccidium). Therefore, it is obvious that extracts of D. morbifera and sweet potato represent ‘novel candidates’ for the production of functional anti-aging agents with minimal side effects. Key words: Dendropanax morbifera and sweet potato, antioxidant activity, cytotoxicity, antimicrobial effects, health-oriented food.

Background/aims To define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea. Methods A total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made. Results The 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the rightside second and third MCP joints were 0.55 and 0.55 mm, and those of the leftside joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology. Conclusion We defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.

Sjögren’s syndrome (SS), a chronic inflammatory disease involving the salivary and lacrimal glands, presents symptoms of sicca as well as systemic manifestations such as fatigue and musculoskeletal pain. Only a few treatments have been successful in management of SS; thus treatment of the disease is challenging. Metformin is the first-line agent for type 2 diabetes and has anti-inflammatory potential. Its immunomodulatory capacity is exerted via activation of 5’ adenosine monophosphate-activated protein kinase (AMPK). Metformin inhibits mitochondrial respiratory chain complex I which leads to change in adenosine mono-phosphate (AMP) to adenosine tri-phosphate (ATP) ratio. This results in AMPK activation and causes inhibition of mammalian target of rapamycin (mTOR). mTOR plays an important role in T cell differentiation and mTOR deficient T cells differentiate into regulatory T cells. In this manner, metformin enhances immunoregulatory response in an individual. mTOR is responsible for B cell proliferation and germinal center (GC) differentiation. Thus, reduction of B cell differentiation into antibody-producing plasma cells occurs via downregulation of mTOR. Due to the lack of suggested treatment for SS, metformin has been considered as a treatment strategy and is expected to ameliorate salivary gland function.

Background Occupational exposure to crystalline silica is a potential risk factor for various systemic autoimmune diseases including systemic sclerosis. The etiology of systemic sclerosis is not conclusively known, but there are epidemiological studies that show the relationship between exposure to crystalline silica and risk of systemic sclerosis. Here we report, for the first time, two cases of crystalline silica-related systemic sclerosis in patients who worked in crystal processing in the jewelry-manufacturing field. Case presentation Case 1 is a 57-year-old man who had worked mainly in crystal processing for multiple jewelry-processing companies for 17 years, since the age of 15 years. He contracted tuberculosis at the age of 25 years and showed Raynaud’s phenomenon of both the hands and feet at age 32 years. Digital cyanosis and sclerosis developed at approximately age 41 years. The patient was diagnosed with systemic sclerosis at age 48 years. Case 2 is a 52-year-old man who worked in crystal processing for various jewelry-processing companies for 7 years, since the age of 23 years. He first showed signs of cyanosis in the third and fourth digits of both hands at age 32 years, was diagnosed with Raynaud’s syndrome at age 37 years, and was diagnosed with systemic sclerosis at age 38 years. Crystal processing is a detailed process that involves slabbing and trimming the selected amethyst and quartz crystals, which requires close proximity of the worker’s face with the target area. In the 1980s and 1990s, the working hours were 12 h per day, and the working environment involved 15 workers crowded into a small, 70-m2 space with poor ventilation. Conclusion Two workers who processed crystals with a maximum crystalline silica content of 56.66% developed systemic sclerosis. Considering the epidemiological and experimental evidence, exposure to crystalline silica dust was an important risk factor for systemic sclerosis. An active intervention is necessary to reduce exposure in similar exposure groups in the field of jewelry processing.

This paper proposes a novel integrated low-voltage dc–dc converter (LDC) and onboard battery charger (OBC) for electric vehicles (xEVs) that share heatsinks, terminals, sensing circuits, and circuit components between both parts. The proposed OBC–LDC integrated power unit (OLPU) can be simplified by modifying the internal connections of the vehicle, thus eliminating the cost of high-power cables. In addition, the OLPU decreases the number of circuit components and increases the total power density by combining or sharing heatsinks, terminals, sensing circuits, and circuit components. Further, the proposed circuit satisfies the performance characteristics of conventional OBCs and LDCs and can be operated as such. Moreover, a simultaneous charging method for both a high-voltage battery and a low-voltage battery is suggested through an additional operational mode that results from the integration. This paper also specifically describes the operating characteristics and the design method in each mode. Design considerations, including possible problems with the integrated circuit structure, are presented, and an additional compensation circuit is suggested to solve these problems. The prototype is built, and experiments are carried out to verify the performance and validity of the proposed power unit.

Background Lipid peroxidation and oxidized LDL (oxLDL) are hallmarks in the development of various metabolic, cardiovascular and other inflammatory diseases. Cholesterol crystals and oxLDL, which are considerably present in atherosclerotic plaques, can activate inflammasomes. The concentration of plasma ox-LDL was also closely associated with the high incidence of atherosclerotic diseases in patients with gout might be closely related to increased ox-LDL levels. However, the study about the relationship between the level of ox-LDL and the inflammatory status in gout patients are rare. Objectives We aimed to the relationships between ox-LDL level, inflammatory markers and uric acid lowering agents in gout patients. Methods One hundred seventy four gout patients were included from the 3 institutions from 2014 to 2017. Details of demographic and clinical features along with laboratory parameters, ESR, CRP, lipid profiles, oxLDL and disease status were noted in patients with gout. We classified inflammatory status as acute, subacute chronic tophaceous and well controlled status. The level of ox-LDL was measured using the latex enhanced immune transmission turbidimetric method. We analyzed the comparison between dermographics, inflammatory markers, lipid profiles and disease subset. Results The primary objective of this study was to assess the oxLDL according to inflammatory status in gouty arthritis. Mean age was 50.4 year-old, 85.7% was woman, 98.9% were male, mean BMI was 25.86 and mean disease duration was 48 months. Among 174 gout patients, 61 patients (35.1%) were acute flare-up, 38 patients (21.8%) were subacute, 67 patients (38.5%) were chronic tophaceous, and 7 patients (4%) were well controlled stable status. Age, sex, BMI, and accompanying disease were not statistically different in the 4 groups according to inflammatory status. However, it showed statistically significant differences in the use of glucocorticoid and uric acid lowering agents. There was no significant difference in uric acid in laboratory tests, but there was a significant difference between ESR and CRP in each disease group. Especially, oxLDL showed difference according to inflammatory state of disease. Conclusion The levels of oxLDL in gout patients were significantly different according to inflammatory status. The oxLDL may be associated with inflammation process in gout patients. Disclosure of Interests None declared

Background: Bosentan is an orally administered dual endothelin-1 (ET-1) receptor antagonist approved in the EU for reducing the number of new digital ulcers in patients with systemic sclerosis (SSc) and ongoing digital ulcer (DU). Oral bosentan therapy was beneficial and generally well tolerated in patients with DU associated with SSc. A total of 3 RCTs were identified. The first two were high quality (RAPIDS-1 and RAPIDS-2) with 122 and 188 patients and treatment durations of 16 and 24 weeks, respectively. Both studies showed that, compared with placebo, bosentan significantly reduced the number of new ulcers; however, it did not have an effect on the healing of preexisting ulcers and pain. Objectives: This study evaluated the efficacy and safety of bosentan in DU secondary to SSc in Korean patients. Methods: From December 2013 to Decemver 2017, a prospective, multicenter, open-label trial was performed to investigate the complete healing of DU and tolerability of bosentan in Korean patients with SSc. The SSc patients were included as having active DU or pulmonary arterial hypertension who had active DU in the last 3 months. A DU was defined as an area with visually discernable depth and a loss of continuity of epithelial coverage, which could be denuded or covered by a scab or necrotic tissue. If the area was denuded, the ulcer was designated active. If denudation could not be judged because of the presence of overlying scab or necrotic tissue, ulcers presenting with features, including underlying pain, based on investigator clinical judgment to be consistent with loss of epithelialization, epidermis, or dermis, and requiring treatment, were designated as active. The effectiveness and tolerability of bosentan was monitored within 24 weeks of study treatment, while healing of DU, largest diameter and the new incidence were also assessed up to week 24. Results: The primary objective of this study was to assess the efficacy of bosentan in reducing DU including the complete healing rate. Secondary endpoints included development of new DU, assessment of discontinuation, measures of nailfold capillaroscopic (NFC) change. Thirty-five SSc patients were enrolled and seventeen patients were included in the NFC analysis. Mean age was 50.5 year-old, 85.7% was woman, 68.6% were diffuse type of SSc, mean mRSS was 15.4 and mean disease duration was 77.9 months. Among 35 patients, 20 patients was finished 24 weeks treatment duration. The main reason for discontinuation is when the patient wants to stop because of the full effect of the drug (n=12, 80%). The side effects of the drug occurred in 4 cases during the treatment period. The mean number of DUs before treatment was 2.4 and was statistically decreased to 1.2 (p=0.001). From the 4th week of bosentan treatment, improvement of DU number was observed in 65.7% and complete healing was observed in 55% at 24 weeks. However, the mean size of largest DU diameter, remained at the end of treatment, was slightly increased from 4.1 to 5.2 mm, with no statistical significance. There was no statistically significant difference in the semi-quantitative changes of NFC before and after bosentan treatment. Conclusion: Administration of bosentan over 24 weeks was statistically associated with complete healing and significant reduction in net number of DU in Korean patients with SSc. However, the size of the remaining DU, that did not respond to bosentan, has rather increased. Disclosure of interests: None declared

To the Editor, Secondary amyloidosis is an important complication of several chronic inflammatory conditions, including rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), and ankylosing spondylitis [1]. It has been demonstrated biochemically that amyloidosis results from abnormal binding of proteins, which are deposited as insoluble fibrils in tissue, leading to disruption of their normal function. An underlying disease of long duration and high activity is the most important factor associated with development of secondary amyloidosis [1]. Treatment of secondary amyloidosis involves suppression of the underlying inflammatory condition. Cytotoxic agents such as cyclophosphamide, chlorambucil, and azathioprine have been shown to have activity against secondary amyloidosis. Tumor necrosis factor α (TNF-α) inhibitor is reportedly effective in controlling the progression of renal amyloids in patients with RA and JIA [2]. Recent biochemical research revealed that synthesis of serum amyloid A (SAA) is controlled by proinflammatory cytokines such as interleukin 6 (IL-6), TNF-α, and IL-1. Control of SAA synthesis could be beneficial to the treatment of amyloidosis, and anti-cytokine therapies are effective in this regard. In particular, inhibition of IL-6 is critical to suppression of SAA production [3]. Recently, the use of biologic agents instead of cytotoxic agents has increased due to their enhanced tolerability and effectiveness [3]. In this paper, we report the use of cyclophosphamide therapy for secondary amyloidosis in a patient with JIA unresponsive to TNF-α inhibitor therapy. A 32-year-old woman was hospitalized for generalized edema and chronic diarrhea. At 12 years of age, she had been diagnosed, based on the International League of Associations for Rheumatology classification criteria, with JIA of the polyarticular, rheumatoid factor-negative type. She had been treated with several disease-modifying RA drugs, including the TNF-α inhibitor adalimumab, 6 months prior. These failed to achieve complete suppression of disease activity. She presented with clinical symptoms of gradually increasing generalized edema and continuous diarrhea of several weeks’ duration. Her medical history was negative for hypertension and renal disease other than JIA. She did not smoke or drink alcohol. Upon physical examination, the patient was normotensive with a regular pulse rate, her lung sounds were clear, her heart sounds were regular, and her abdomen was soft; however, her bowel sounds were mildly increased. She had grade 3 pitting edema on a pretibial lesion. Neurologic examination was normal, and an electrocardiogram showed a normal sinus rhythm. Laboratory test results revealed the following: proteinuria (+++), blood (trace), erythrocytes in the urine (1 to 4/high power field), and a 24-hour quantitative protein level of 3,782 mg/day. Her serum creatinine level was elevated to 2.70 mg/dL, and her fractional excretion of sodium was 2.34. Her hemoglobin level was 11.5 g/dL, hematocrit concentration was 37.8%, white blood cell count was 9,590/mm3 (neutrophils, 79.6%), platelet count was 537,000/mm3, sodium level was 138 mEq/L, potassium level was 4.0 mEq/L, total protein level was 5.2 mg/dL, albumin level was 1.7 mg/dL, and procalcitonin level was 0.264 ng/mL (reference range, 0 to 0.5). No white blood cells were evident upon microscopic examination of the patient’s stool. The results of other tests were as follows: antinuclear antibody (−), rheumatoid factor 10.4 IU/mL (reference range, 0 to 15), anti-cyclic citrullinated peptide antibody (−), free kappa light chain 67 mg/L, free lambda light chain 229 mg/dL, hepatitis B surface antigen (−), hepatitis B surface antibody (+), anti-hepatitis C virus antibody (−), and human immunodeficiency virus test (−). The patient had nephritic-range proteinuria and an elevated serum creatinine; therefore, she underwent a renal biopsy. Light microscopy showed homogenous amorphous material in the glomerular mesangium and interstitium. Congo red staining was positive with birefringence in the arteries, arterioles, interstitial areas, and mesangium of the glomeruli (Fig. 1). Duodenal endoscopy and colonoscopy were performed to identify involvement of other organs. Amorphous material was seen in the mucosa and submucosa of the duodenum and in the muscular layer of the wall of the rectum (Fig. 2). Neither cardiac wall thickness nor a granular sparkling appearance was identified by echocardiogram. Figure 1. Pathologic findings of renal biopsy. Deposition of amyloid in glomerular mesangium and interstitium (arrows) (A, HE B, Congo Red staining, ×400). Figure 2. Pathologic findings of endoscopic biopsy. (A) Deposition of amyloid in mucosa and submucosa of duodenum and (B) in muscular layer of rectum (arrows; H&E, ×40). Based on the results of renal, duodenal, and rectal biopsies, we diagnosed secondary systemic amyloidosis as a result of long-standing JIA. Due to the resistance to previous TNF-α inhibitor therapy and elevation of the serum creatinine level, treatment with cyclophosphamide and a glucocorticoid was started. Cyclophosphamide pulse therapy at a dose of 500 mg/m2 was administered intravenously at 1-month intervals for a 6-month period. After 6 months of treatment, the serum creatinine had normalized, proteinuria had been reduced (1,119 mg/day), the C-reactive protein level was 0.1 mg/dL, and the edema had disappeared. Additionally, the patient’s disease activity was improved after 6 months of cyclophosphamide treatment. Based on the European League Against Rheumatism response criteria, the patient showed a good response range. Her laboratory findings on admission and at the 6-month follow-up from the nephrology clinic are presented in Table 1. At the time of this writing, the patient was undergoing treatment with an oral steroid at 30 mg/day and hydroxychloroquine at 400 mg/day. Table 1. Laboratory findings from baseline to 6 months after cyclophosphamide plus glucocorticoid treatment in secondary amyloidosis patient Secondary systemic amyloidosis is a serious complication of chronic inflammatory disease and results in the deposition of amyloid fibrils in various organs [4]. These fibrils are derived from circulating acute-phase reactant SAA protein. Currently, the most common cause of amyloidosis is inflammatory arthritis; e.g., RA and JIA. It is estimated that 5% of adults with RA will develop secondary amyloidosis. The main feature of amyloidosis at diagnosis is renal dysfunction, and the most common finding is proteinuria, which is not necessarily present at disease onset. Traditional management of secondary amyloid has been to target the disease underlying the inflammation [4]. Several case studies have shown benefits with the use of methotrexate and azathioprine or prednisolone in patients with rheumatoid-associated amyloid A (AA) amyloidosis, but the response is often slow. Cytotoxic agents, such as chlorambucil and cyclophosphamide, have been shown to be beneficial in clinical trials, but these drugs are associated with myelotoxicity, leukemia, and sterility. Moreover, several trials have reported that the TNF-α inhibitor etanercept is more effective than cyclophosphamide [3]. In recent years, the use of biologics with activities against proinflammatory cytokines such as TNF-α, IL-1, and IL-6 for diseases such as RA, psoriatic arthritis, and ankylosing spondylitis has increased. This class of drugs has become more clinically available. TNF-α may be involved in the deposition of amyloid and the development of nephrotic syndrome. TNF-α stimulates hepatocytes to produce SAA and has also been shown to have a direct inflammatory effect on the glomerular basement membrane. Elevated levels of SAA in RA are known to predispose to amyloidosis. Anti-TNF-α therapy suppresses SAA, and maintaining an SAA level of < 10 mg/L is associated with potential recovery of amyloidotic organs in AA amyloidosis. IL-6 blockade using the humanized anti-IL-6 receptor antibody tocilizumab may be more effective than TNF blockade in terms of normalizing SAA levels in patients with rheumatic disease, suggesting it to be a more effective strategy for treating AA amyloidosis in these disorders [5]. Our patient exhibited marked resistance to treatment with a steroid and TNF-α inhibitor, and she had nephrotic-range proteinuria and reduced renal function. We administered cyclophosphamide plus a glucocorticoid instead of other biologic agents and achieved a good outcome. Use of biological modifiers represents an important therapeutic strategy for secondary amyloidosis, but cases unresponsive to TNF-α treatment are frequently reported. In such cases, cyclophosphamide should be considered as a second-line therapy.

Objectives Celecoxib is a selective cyclooxygenase (COX)-2 inhibitor that is commonly used to reduce the incidence of gastrointestinal (GI) complications in patients with rheumatoid arthritis (RA). CELBESTA® is a generic equivalent to CELEBREX®, a celecoxib preparation. This study compared the efficacy and safety of CELBESTA® and CELEBREX® in patients with RA. Methods This was a multicenter, double-blind, double-dummy, active-controlled, randomized, parallel-group, non-inferiority clinical trial. The primary endpoint was a change from baseline in self-assessed pain intensity determined using a 100-mm visual analog scale after 6 weeks of treatment. Results After a washout period, 119 eligible subjects were randomized to one of two groups (CELBESTA® group, n = 61; CELEBREX® group, n = 58). CELBESTA® was not inferior to CELEBREX® because the upper limit of two-sided 95% confidence interval (CI) for the difference between the two groups (difference in the least square [LS] mean, −8.68 mm; two-sided 95% CI −16.59 mm to −0.77 mm) was less than the non-inferiority margin (10 mm). There were no significant differences in GI complications and renal toxicity. Conclusions CELBESTA® was not inferior to CELEBREX® with regard to the pain relief efficacy in RA patients, and the tolerability and safety profiles were excellent and at similar levels for both preparations.

Recent studies have shown that a combination treatment of mycophenolate mofetil (MMF) and tacrolimus (TAC) may be an option for lupus nephritis (LN) patients that do not adequately respond to initial treatment. We evaluated the efficacy and safety of the combination treatment of MMF and TAC in LN patients with suboptimal response to prior MMF or TAC treatments.In this multicentre study, we retrospectively enrolled 62 patients with class III, IV, or V LN who inadequately responded to MMF or TAC treatment. Those patients were then treated with a combination of MMF and TAC for 6 months. The primary outcome was complete remission (CR) at 6 months, and secondary outcomes included overall response and adverse events.After 6 months of treatment with the drug combination, CR was achieved in 14 of 62 patients (22.6%), and 35 (56.5%) patients responded. A significant reduction in proteinuria and lupus disease activity score was observable after 3 months. After 1 year, the CR rate increased to 36.4% (20 of 55 patients), and the overall response rate (n=38, 69.1%) also increased from 6 months. Twenty-one patients reported 29 adverse events, including severe infection requiring hospitalisation (n=3, 10.3%), infection not requiring hospitalisation (n=2, 6.9%), and herpes zoster (n=4, 13.8%).Our findings suggest that a combined MMF and TAC treatment, with a favourable adverse-event profile, may be a beneficial option for LN patients with inadequate response to either MMF or TAC treatments.

Ultrasonography (US) is a cost effective diagnostic imaging tool suitable for routine clinical use. High frequency US is a well-established method for both the diagnosis and monitoring of inflammatory arthritis, capable of detecting a wide range of joint pathologies, including effusion, synovitis, and extra-articular abnormalities. However, to ensure an accurate diagnosis, it is also important to consider periarticular disorders that could clinically mimic joint pathology. Such a diagnosis requires special attention to be paid to the periarticular structures, include the tendon, ligament, muscle, and bursa. Due to the close proximity of these structures to potentially affected joints, periarticular inflammation is often clinically misdiagnosed as articular in origin. In these cases, the processes driving pathology are the result of localized inflammation that is secondary to inflammatory arthritis, such as excessive friction or direct trauma. Therefore, when using US to diagnose inflammatory arthritis, it is important to understand the causative pathology of the periarticular disorders, as well as their clinical presentation. (Korean J Med 2015;89:620-631)

Background/aims Gout is a common inf lammatory arthritis triggered by the crystallization of uric acid in the joints. Serum uric acid levels are highly heritable, suggesting a strong genetic component. Independent studies to confirm the genetic associations with gout in various ethnic populations are warranted. We investigated the association of polymorphisms in the ABCG2 and SLC2A9 genes with gout in Korean patients and healthy individuals. Methods We consecutively enrolled 109 patients with gout and 102 healthy controls. The diagnosis of gout was based on the preliminary criteria of the America College of Rheumatology. Genomic DNA was extracted from whole blood samples. We identified single nucleotide polymorphism (SNP) changes in the ABCG2 and SLC2A9 genes using a direct sequencing technique. rs2231142 in ABCG2 and rs6449213 and rs16890979 in SLC2A9 and nearby regions were amplified by polymerase chain reaction. Results Patients with gout had significantly higher A/A genotype (29.3% vs. 4.9%, respectively) and A allele (52.8% vs. 26.5%, respectively) frequencies of rs2231142 in ABCG2 than did controls (χ(2) = 29.42, p G and c.1002+78G>A) in the SLC2A9 gene. The univariate logistic regression analysis revealed that the c.881A>G and c.1002+78G>A SNPs were significantly higher in patients than in controls. Conclusions We demonstrated a significant association between rs2231142 in the ABCG2 gene and gout and identified novel SNPs, c.881A>G and c.1002+78G>A, in the SLC2A9 gene that may be associated with gout in a Korean population.

This paper presents an analysis of the mechanism of failure modes in bi-directional phaseshift full-bridge converters, composed of MOSFET, based on the circuit operation and parasitic parameters of MOSFET. In addition, the relation between circuit operation and parameters is suggested through an experimental comparison. From this relation, the suitable ranges of parameters for stable performance are analyzed. The design criteria of the bi-directional phase-shift full-bridge converter are presented and evaluated from the experimental verification.

Recently, the needle-free delivery system has been widely used in medical fields due to its convenience in delivering drug particles into human body without any external needles. In order to penetrate through the outer layer of the skin, drug particles need to obtain enough momentum, which is achieved by accelerating drug particles in a Contoured Shock Tube (CST). The CST consists of a micro shock tube with two diaphragms and an expanded supersonic nozzle. In the present study, experimental studies were carried out by pressure measurement. Six high sensitive pressure transducers were used for recording pressure changes as the shock wave moved through different locations along walls in the test section. From which, data on shock wave propagation could be obtained. Different diaphragm pressure ratios were conducted to demonstrate effects of initial diaphragm pressure ratios on shock wave propagation. Shilieren visualization was also performed to observe shock wave propagation and shock wave structure in the present experimental shock tube model. The characteristic of the internal flow and shock wave system have been studied and analyzed in details in the present shock tube model.

Background Doxycycline is currently the most frequently used treatment in patients with scrub typhus. However, doxycycline-resistant strains have been found, necessitating the development of a new treatment. Rifampin is known to be effective even for such strains. Our aim in this study was to compare the effects of rifampin and doxycycline treatment in patients with scrub typhus in areas in which resistance to doxycycline has not been reported. Methods Patients admitted to Chosun University Hospital and regional network hospitals between 2007 and 2009 with a body temperature ≥37.5°C and suspected to have scrub typhus were randomly assigned to 1 of 2 treatment groups: a group administered doxycycline 100 mg twice daily for 5 days and a group administered rifampin 600 mg once daily for 5 days. For treatment outcomes, fever, headache, muscle ache, and rash clearance times were compared between the groups. Results The rifampin and doxycycline groups showed equivalence in all treatment outcomes evaluated. The proportions of patients with fever clearance within 48 hours were similar between groups. Furthermore, there was no significant difference in the occurrence of side effects following drug administration between groups. Conclusions On the basis of the finding that equivalent treatment effects and safety were found in patient groups that received 600 mg of rifampin and 200 mg of doxycycline, respectively, for 5 days to treat scrub typhus, rifampin may be considered an alternative treatment to doxycycline. Clinical trials registration NCT00568711.

In this paper, for the development of a safe and reliable DC home appliance suitable for DC home power supply system, we classified a number of inherent problems with help of the comparative analysis of existing AC and new DC home appliance. Several new technical problems of DC home appliances are mainly linked to the DC transient state. Among them, this paper concentrates on start-up inrush current problem, uni-polarity problem, and heavy DC load control problem. And to address these problems, we herein present an implementation of robust safety circuits for DC home appliances. Specifically, we investigate several multi-circuit countermeasures and select the best among them through comparative evaluation, based on theoretical, simulational, and experimental results.

In this paper, the efficiency and power factor performance of improved power factor correction (PFC) topologies suitable for a high density and efficient design are compared. Several topologies, including a conventional average current mode control boost PFC, an interleaved boost PFC, a back-to-back bridgeless boost PFC, and a semi-bridgeless boost PFC, are assessed through loss analysis and simulation using whole height 1 U and 2 kW class prototypes. Based on this, an optimal topology is selected for which an additional comparative analysis involving input line measure improvement control is conducted. The results of these experiments can be adapted for use in the circuit selection of high-performance converters with power factor improvement circuits.

Unilateral pedicle stress fracture accompanying spondylolytic spondylolisthesis is rare even in the elderly. Most are associated with major trauma, previous spine surgery, or stress-related activity. Here, the authors describe an unique case of unilateral pedicle fracture associated with spondylolytic spondylolisthesis at the L5 level, which was successfully treated by posterior lumbar interbody fusion with screw fixation at the L5-S1 level. As far as the authors' knowledge, no such case has been previously reported in the literature. The pathophysiological mechanism of this uncommon entity is discussed and a review of relevant literature is included.

The design and implementation of a high-efficiency nonisolated single-stage on-board battery charger (OBC) for electric vehicles are presented. Reviewing the conventional topologies, a suitable circuit structure is determined to charge a battery in a wide spectrum of input and output conditions. Additionally, a suitable strategy for a highly efficient OBC is presented through the analysis of selected topology. A detailed theoretical analysis, operating strategy, and experimental results on a 3.7-kW prototype are presented in order to evaluate the performance of the proposed system.

Most eco-friendly cars can adopt the concept of an integrated battery charger (IBC), which uses currently available motor drive systems. The IBC has a lot of strong points such as low cost and minimum space for the high voltage battery charger. On the other hand, it also has some defects caused by its structure. In this paper, the shortcomings of the conventional IBC for PHEVs with interior permanent magnet motors are discussed, and two advanced IBCs with improved performance are presented. Compared with the conventional IBC, the two advanced IBCs have plenty of strengths such as low common noise, high efficiency, simple sensing methods, etc. Then, the digital control algorithm is modified and a power loss calculation is carried out with simulation software. Finally, experimental results are provided to show the performance of the IBC systems.

This paper reports the development of test bed with the energy recovering technique using two-step boost converter. The device is utilized for LDC aging test of Hyundai Motor's LPI AVANTE HEV in mass production. The developed power recycle type test bed is designed as 1.5 kW class to test up to the maximum load power of LDC and is also designed to supply scant power supply up to 500 W after power recycle. The theoretical design analysis and operational characteristics analysis results of test bed are reported, and its practicality and reliability are verified through the test result. Also, the finally developed test bed confirms approximately 79~85 % energy saving effect compared to the usual traditional aging test system. DC-DC converters used in eco-friendly electric vehicles such as Hybrid Electric Vehicles (HEVs) and Electric Vehicles (EVs) needs the high reliability than the existing converter for industrial and home use. Especially, the high reliability from the production stage is required for low DC-DC converter (LDC) because LDC belongs to driving system. In general aging tests of LDCs, external input power is required, and output power is lost as heat through the load device. Accordingly, solutions to reduce input power installation cost and get rid of load heat consumption during aging tests are required. This study introduces a way to reuse the input of LDC by recycling output power. The proposed power recycling structure is an energy cyclic structure, as show in Fig. 1(b). Meanwhile, Fig. 1(a) is a common test environment, and it consists of the input power supply device and output load resistor or output electronic load. At that time, all of output load capacity and LDC losses should supply from input power supply device and they are burned as heat from load device. The developed test bed activates LDC by setting the input at low capacity after the initial startup. The low-level output voltage of an LDC is used as an input source of the test device. The developed test bed supplies this voltage again to the LDC by boosting it up to the LDC input level. At this time, LDC loss energy is compensated by additionally using external power. Therefore, the demand energy for LDC aging is saved as much as the sum of loss energy form the LDC and that form the test device. This paper explains the operation characteristics of configuration circuit and the running sequence of test bed. Also, the great of the proposed method is verified by measuring the saved power compared to the traditional system through the actual aging test.

This study is to update of vibration power generating model and to analyze electromotive force on subway. Analysis of electromotive force using power generation depending on classification of locations which are ballast bed and concrete bed. As the section between Seocho and Bangbae in the line 2 subway was changed from ballast bed to concrete bed, it could be analyzed at same condition, train, section. Induced electromotive force equation by Faraday's law was updated using Bayesian regression and correlation analysis with calculate value and experiment value. Using the updated model, it could get 40mV per one power generation in ballast bed, and it also could get 4mV per one power generation in concrete bed. If the updated model apply to subway or any train, it will be more effective to get electric power. In addition to that, it will be good to reduce greenhouse gas and to build a green traffic network Keywords :energy harvesting, dynamic characteristic, bayesian regression, induced electromotive

This paper describes a theoretical and experimental study on a seamless transfer control strategy for the parallel operation of three-phase voltage source inverters (VSIs) for energy storage systems (ESSs). Moreover, phase-locked loop, seamless transfer control, and parallel control algorithm are optimized for simplicity in order to implement in a unified-controller. Finally, the proposed algorithm is validated through informative simulation waveforms and experimental results

Existing energy sources convert chemical energy into mechanical energy, while fuel cell directly generates electricity through an electrochemical reaction between hydrogen and oxygen. Therefore, it has a lot of strong points such as high efficiency, zero emission, and etc. In addition, with the development of hydrogen preservation technique, some companies have been researching and releasing portable fuel cell power packs for specific applications like military equipment, automobile, and so on. However, there are some drawbacks to the fuel cell, high cost and slow dynamic response. In order to compensate these weak points, auxiliary energy storages could be applied to the fuel cell system. In this paper, the optimum structure for a 150W portable fuel cell power pack with a battery pack is selected considering the specification of the system, and the design process of main parts is described in detail. Here, main objectives are compact size, simple control, high efficiency, and low cost. Then, an automatic mode change algorithm, which converts the operating mode depending on the states of fuel cell stack, battery pack, and load, is introduced. Finally, performance of the designed prototype using the automatic mode change control is verified through experiments.

Purpose: This study examined the effects of taekwondo exercise program on the physical function, fitness and quality of life in women with osteoarthritis. Met hods: With nonequivalent control group quasi-experimental design, 17 outpatients with osteoarthritis were recruited from June to August, 2010. The subjects were divided into 14 in experimental group and 13 in control group. The taekwondo exercise program was consisted of public taekwondo gymnastics with stretching movement and carried out every 60 minutes, 2 times a week for 12 weeks. Physical fitness of sit up, sit and reach, and agility, KWOMAC, and quality of life were measured. Data were analyzed by t-test and Mann-Whitney test using SPSS program. Results: After the intervention, the physical fitness for muscle endurance (Z=-4.40, p

This paper presents CAN-based parallel-operation and load-sharing techniques for the communication server power supply. With the load information obtained through CAN communication, each modules performs its current control independently and the power unbalance caused by impedance differences of converter modules can be reduced. In conventional method, slave modules are controlled by master module. On the other hand, the proposed load share algorithm uses the Multi-Master method. Therefore, accurate load sharing can be accomplished by the reference structure of each module`s average current. Each converter has two stages and it is separated into PFC, which is responsible for harmonic regulation, and LLC resonant converter, which controls output voltage. To verified the performance of the proposed method, two 2KW prototypes has been implemented and experimented.

Nan-Young Kim*, Young-Sug Kim, Myung-Gil Kim, Hong-Rae Jung, Yun-Sung Kim, Han-Taek Kim, Sun-Woo Lee, Kyeng-Suk Chae and Mi-Hye YoonAnyang Agricultural Products Inspection Center, Gyeonggi-do Institute of Health & EnvironmentWe analysed 149 samples of Korean traditional herbal tea materials. The 156 pesticides were analyzed by GC/ECD and NPD, detected pesticides were confirmed by GC-TOF/MS. Sample preparation was performed bv multi-residue analysis method of multiclass pesticides of the Korea Food Code. The residual pesticides were detected in 22 samples(14.8%), the highest detection frequency samples are lycium and jujube. Detected pesticides in Korean traditional herbal tea materials were chlorpyrifos (5 samples), chlorothalonil (3 samples), cypermethrin (3 samples), hexaconazol (3 samples) and cyhalothrin(3 samples). The pesticide types detected in Korean traditional herbal tea materials were organophosphorus(29.2%), pyrethroids(16.7%), organochlorines (12.5%) and triazoles(12.5%). The 5 samples(lycium, jujube, chrysanthemum, balloon-flower, milk vetch root) were detected pesticides below MRLs, 2 samples(cornus fruit, cnidium) were detected pesticides unnotificated MRLs. Key words herbal tea, herbal medicine, GC-ECD, GC-NPDAbstract

Soybean-based food items have been developed as common fermented side dish sauces in South Korea, Japan, and China. Each of these countries, however, has its own fermentation method, including a microorganism-based fermentation process, the mixing of ingredients, the fermentation process, and the mixing of starch. The purpose of this study was to determine the quality characteristics of the commercial product. Fourteen kinds of rice soybean paste (Korea, 2 Japan, 12) were prepared, and their physiochemical properties (ammonium nitrogen, amino nitrogen, amylase, protease, and reducing-sugar contents) were analyzed. JRD-1 was found to contain the highest amount of amino-type nitrogen (426.45 mg%) while KRD-2 showed 316.10 mg%. For the protease activities, the following results were obtained: JRD-9, 695.10 unit/g JRD-11, 671.45 unit/g and JRD-5, 665.03 unit/g. As for the amylase activities, the results that were obtained were JRD-7, 53.65 unit/g JRD-8, 50.71 unit/g KRD-1, 46.52 unit/g JRD-1, 46.29 unit/g and JRD-11, 33.61 unit/g. This research provided information for the quality characteristics of commercial rice soybean paste.

A Ni 3 Al intermetallic compound was added to the cathode to decrease the solubility of Ni in a Li/K eutectic molten salt. The solubility of Ni/Ni 3 Al used as a cathode was examined by measuring the concentrations of Ni and Al ions in alkali metal carbonate. The electrolyte consisted of a mixture of lithium carbonate and potassium carbonate (62Li 2 CO 3 –38K 2 CO 3 ) at 650 °C. A significant decrease in Ni precipitation was observed over a long term operation using a Ni/(4%, 7%, 10%) Ni 3 Al stabilized cathode. Al is easily oxidized and forms an Al 2 O 3 film on the surface. This Al 2 O 3 film can inhibit corrosion of the electrode. The solubility of the Ni–Al oxidized electrodes containing Ni 3 Al and NiO decreased with increasing amounts of Ni 3 Al added and with increasing sintering temperature. The solubility decreased to 1.57 ppm, which is 1/10 that of the pure NiO cathode.

In this study, we evaluated and compared the virulence of Magnaporthe oryzae isolates sensitive and resistant to the phosphorothiolate fungicides, edifenphos and iprobenfos on rice plants treated with or without fungicides. Monoconidial isolates of M. oryzae sensitive and resistant to the fungicides were selected from our previous relative mycelial growth assay of 1080 isolates on fungicide-amended media. When six-leaf stage rice plants treated with different concentrations of the fungicides were inoculated with four resistant and four sensitive isolates of M. oryzae , the lowest concentrations showing virulence differences were twice the minimum inhibitory concentrations (MICs) of edifenphos (40 μg a.i. ml −1 ) and iprobenfos (110 μg a.i. ml −1 ). Therefore, two MICs were used as discriminatory concentrations for further virulence tests of 20 sensitive and 20 resistant isolates of M. oryzae . Isolates resistant to edifenphos produced greater disease severity and susceptible lesion number per leaf area (SLNLA) than sensitive isolates on rice plants regardless of treatments. Reduction of disease severity and SLNLA was greater for sensitive than resistant isolates on edifenphos-treated plants compared to untreated controls. Similar results were obtained with iprobenfos, but disease severity or SLNLA of resistant isolates were not affected by iprobenfos compared to untreated controls. In this study, it was evident that resistant isolates of M. oryzae were more virulent than sensitive isolates on rice plants and were less affected by the phosphorothiolate fungicides. Therefore, rice blast management programs should consider a potential adaptation in M. oryzae populations for increased phosphorothiolate-fungicide resistance.

This paper describes the application of a quasi-one-demensional (1D) network, bubble model to simulate the filtration of a microfine cement suspension injected through a column of sand. The bubble model represents the soil column as a series of homogeneous sites linked through bundles of cylindrical bonds that characterize the distribution of pores. The model captures mechanisms of particle sieving at the inlet sites and infiltration within each of the bonds under the action of hydrodynamic and gravitational forces. The behavior of each bond is based on numerical simulations of particle transport, collection, mounding, and clogging within a cylindrical model pore. Two empirical parameters are introduced to account for uncertainties in particle attachment at the pore wall and observed mechanisms of resuspension of hindered particles. In principal, these parameters can be calibrated from measurements of effluent concentrations. The bubble model provides useful physical insights to explain the transient dyna...

In this study, the sensitivity of Magnaporthe oryzae isolates from different geographic areas in Korea to two phosphorothiolate (PTL) fungicides, edifenphos and iprobenfos, was determined. A total of 1080 M. oryzae isolates were collected from rice-cultivating fields in 11 locations throughout Korea in 1997 and 1998. The minimum inhibitory concentrations (MICs) of edifenphos (20 μg a.i. ml −1 ) and iprobenfos (55 μg a.i. ml −1 ) against seven representative sensitive isolates of M. oryzae were determined from the dose-response curves, and the MICs were then used as single discriminatory concentrations for the detection of fungicide resistance. Of the 1080 tested isolates, the isolates less sensitive to edifenphos and iprobenfos were 57 and 84%, respectively, and 53% of the isolates were less sensitive to both fungicides. Approximately 11% of all tested isolates showed no growth at the MICs of the tested fungicides. Isolates with a relative mycelial growth of 0.05 to edifenphos occurred at the greatest frequency (33%); isolates with a relative growth of 0.3 to iprobenfos occurred at the greatest frequency (23%). The frequency distribution of isolates sensitive to either edifenphos or iprobenfos varied with geographic location. The two-sample median test yielded high medians in the Kwangju and Chonju isolates for edifenphos, and in the Kwangju, Donghae, and Yangyang isolates for iprobenfos, but low medians in the Kangnung isolates for edifenphos and in the Kangnung, Gwangju, and Chunchon isolates for iprobenfos, respectively, as compared to the isolates from the other locations. Analysis of Spearman's rank correlation test showed a significantly positive relationship ( r = 0.490, P M. oryzae populations collected from different geographic areas in Korea, and isolates less sensitive to these fungicides exhibit cross-resistance with each other.