Prevention and Treatment of Multiple Osteoporotic Compression Fracture

Korea's demographic profile is undergoing tremendous change as the country rapidly ages at one of the fastest rates in the world. Indeed, the country is expected to become an "aged society" in 2018 when the proportion of elderly is estimated to reach 14.3% of the total population. With the notable increase in the number of elderly individuals, the incidence of osteoporotic fractures will also likely increase. Osteoporosis is a systemic musculoskeletal disease that is characterized by the decreased bone quantity and the abnormalities of the microstructures. There are both conservative and surgical treatment modalities for the fracture: conservative treatments include pharmacological treatments and orthosis; surgical treatments include vertebroplasty, kyphoplasty, and reconstructive surgery. Clinicians should consider the severity of osteoporosis, the concurrent osteoporotic fracture, the age and sex of the patient, and the underlying diseases in making a patient-tailored prescription

Proximal Junctional Kyphosis: Diagnosis, Pathogenesis, and Treatment

Proximal junctional kyphosis (PJK) is a common radiographic finding after long spinal fusion. A number of studies on the causes, risk factors, prevention, and treatment of PJK have been conducted. However, no clear definition of PJK has been established. In this paper, we aimed to clarify the diagnosis, prevention, and treatment of PJK by reviewing relevant papers that have been published to date. A literature search was conducted on PubMed using "proximal junctional", "proximal junctional kyphosis", and "proximal junctional failure" as search keywords. Only studies that were published in English were included in this study. The incidence of PJK ranges from 5% to 46%, and it has been reported that 66% of cases occur 3 months after surgery and approximately 80% occur within 18 months. A number of studies have reported that there is no significantly different clinical outcome between PJK patients and non-PJK patients. One study showed that PJK patients expressed more pain than non-PJK patients. However, recent studies focused on proximal junctional failure (PJF), which is accepted as a severe form of PJK. PJF showed significant adverse impact in clinical aspect such as pain, neurologic deficit, ambulatory difficulties, and social isolation. Numerous previous studies have identified various risk factors and reported on the treatment and prevention of PJK. Based on these studies, we determined the clinical significance and impact of PJK. In addition, it is important to find a strategic approach to the proper treatment of PJK

Clinical and molecular genetics of neonatal diabetes due to mutations in the insulin gene

Over the last decade our insight into the causes of neonatal diabetes has greatly expanded. Neonatal diabetes was once considered a variant of type 1 diabetes that presented early in life. Recent advances in our understanding of this disorder have established that neonatal diabetes is not an autoimmune disease, but rather is a monogenic form of diabetes resulting from mutations in a number of different genes encoding proteins that play a key role in the normal function of the pancreatic beta-cell. Moreover, a correct genetic diagnosis can affect treatment and clinical outcome. This is especially true for patients with mutations in the genes KCNJ11 or ABCC8 that encode the two protein subunits (Kir6.2 and SUR1, respectively) of the ATP-sensitive potassium channel. These patients can be treated with oral sulfonylurea drugs with better glycemic control and quality of life. Recently, mutations in the insulin gene (INS) itself have been identified as another cause of neonatal diabetes. In this article, we review the role of INS mutations in the pathophysiology of neonatal diabetes

Evaluation of the sensitization rates and identification of IgE-binding components in wild and genetically modified potatoes in patients with allergic disorders

BACKGROUND: The potato is one of the most common types of genetically modified (GM) food. However, there are no published data evaluating the impact of genetic manipulations on the allergenicity of GM potatoes. To compare the allergenicity of GM potatoes with that of wild-type potatoes using in vivo and in vitro methods in adult allergy patients sensitized to potatoes. METHODS: A total of 1886 patients with various allergic diseases and 38 healthy controls participated in the study. Skin-prick testing and IgE-ELISA were carried out with extracts prepared from wild-type and GM potatoes. An ELISA inhibition test was used to confirm the binding specificity. IgE-binding components in extracts from the two types of potato were identified by SDS-PAGE and IgE-immunoblotting. The effects of digestive enzymes and heat on the allergenicity of the extracts was evaluated by preincubating the potatoes with or without simulated gastric and intestinal fluids in the absence or presence of heat. RESULTS: Positive responses (ratio of the wheal size induced by the allergen to that induced by histamine (A/H) ≥ 2+) to wild-type or GM potato extracts, as demonstrated by the skin-prick test, were observed in 108 patients (5.7%). Serum-specific IgE was detected in 0–88% of subjects who tested positively. ELISA inhibition tests indicated significant inhibition when extract from each type of potato was added. IgE-immunoblot analysis demonstrated the presence of 14 IgE-binding components within the wild-type potato and 9 within the GM potato. Furthermore, a common 45-kDa binding component that yielded similar IgE-binding patterns was noted in more than 80% of the reactions using sera from patients sensitized to wild-type or GM potato. Exposure to simulated gastric fluid and heat treatment similarly inhibited IgE binding by extracts from wild-type and GM potatoes, whereas minimal changes were obtained following exposure of the extracts to simulated intestinal fluid. CONCLUSION: Our results strongly suggest that genetic manipulation of potatoes does not increase their allergenic risk. The sensitization rate of adult allergy patients to both types of extract was 5.7%, and a common major allergen (45 kDa) was identified

Regeneration Ecology of Chrysopogon aucheri and Cymbopogon jwarancusa in Grasslands of Upland Balochistan , Pakistan

Field experiments were conducted to investigate the seed attributes, movements and fates of dispersal units, and seedling establishment of Chrysopogon aucheri and Cymbopogon jwarancusa in a representative grassland ecosystem in upland Balochistan, Pakistan. Cymbopogon jwarancusa had more filled and viable caryopses than Chrysopogon aucheri. Seeds (spikelets) of both species had similar morphological features. Chrysopogon aucheri had one dispersal unit, a triplet spikelet. Cymbopogon jwarancusa had four types of dispersal units: a paired spikelet, a partial raceme, an entire raceme, and a partial inflorescence comprised of two racemes. Paired spikelets and partial racemes of Cymbopogon jwarancusa had greater mean dispersal distances (94 and 101 cm) from the edge of the basal crown of marked plants to the ground surface than triplet spikelets of Chrysopogon aucheri (79 cm). Spikelets of Cymbopogon jwarancusa and Chrysopogon aucheri moved mean distances of 26 and 32 cm, respectively, on the ground surface before becoming trapped in a microhabitat. The mean angle of dispersal for both species was toward the northeast, according to the prevailing wind direction. An ant (Tica verona) was the only detected seed (spikelet) predator for Chrysopogon aucheri. Both species had a weakly persistent soil seed bank, with higher amounts of seeds found under plant canopies compared to open interspaces. The recruitment of Chrysopogon aucheri and Cymbopogon jwarancusa seedlings from the natural seed bank was monitored in seven different microhabitats under natural and above-normal precipitation regimes . Above-normal precipitation increased seedling recruitment for both species in all microhabitats. Cymbopogon jwarancusa had higher seedling densities than Chrysopogon auchfiri. Seedling survival and tiller development for both species were greatest in the gravel microhabitat in the natural precipitation treatment. Monsoon rains in late July enhanced emergence of both species from recently dispersed seeds but emerged seedlings did not survive to the end of the growing season. The field studies indicate that Cymbopogon jwarancusa has a greater regeneration potential than Chrysopogon aucheri in this grassland ecosystem in upland Balochistan. It may be difficult to increase the composition of Chrysopogon aucheri, the more desirable species in these grasslands, when using management techniques that rely on natural regeneration

Cytokeratin Autoantibodies: Useful Serologic Markers for Toluene Diisocyanate-Induced Asthma

To evaluate the clinical significance of autoantibodies to three major epithelial cytokeratins (CK) - CK8, CK18, and CK19 - we compared 66 patients with toluene diisocyanate (TDI)-induced asthma (group I) with three control groups: 169 asymptomatic exposed subjects (group II), 64 patients with allergic asthma (group III), and 123 unexposed healthy subjects (group IV). Serum IgG, specific for human recombinant CKs, were measured by ELISA (enzyme linked immunosorbent assay), and ELISA inhibition tests were performed. The existence of these antibodies was confirmed by IgG immunoblot analysis. Anti-TDI-HSA (human serum albumin) IgE and IgG antibodies were measured by ELISA in the same set of the patients. The prevalence of CK8, CK18, and CK19 auotantibodies in group I was significantly higher than in the other three groups. Results of the ELISA inhibition test showed significant inhibition with the addition of three CKs in a dose-dependent manner. No significant association was found between CK autoantibodies and the prevalence of anti-TDI-HSA IgG and IgE antibodies. These results suggest that autoantibodies to CK18 and CK19 can be used as serologic markers for identifying patients with TDI-induced asthma among exposed workers

Early Union of Grafted Bone in Ankylosing Spondylitis: Comparative Study with Degenerative Spinal Disease

Patients with ankylosing spondylitis (AS) achieve early bone union compared to those with other spinal diseases. This study compared the time to bone union after surgery between AS patients and degenerative spinal disease patients. Patients with degenerative spinal diseases (control group) and AS (experimental group) underwent pedicle subtraction osteotomy followed by posterolateral fusion, and decompression and posterolateral fusion, respectively. There were 10 patients in the experimental group. The control group included 26 patients who were less than 50 years of age and underwent two-level autogenous grafting after decompression and spinal fusion. Autogenous grafts and a range of bone substitutes were used in the experimental group, whereas only autogenous grafts were used in the control group. Bone union was determined on the radiographs and 3-dimensional CT scan images. The level of union was assessed using the Lenke's and Christensen's classification systems. In the experimental group, the mean age was 41.3 years (range, 30 to 67 years), the mean follow-up period was 21.7 months (range, 12 to 43 months), and bone union was confirmed at an average of 3.5 months (range, 3 to 5 months) after surgery. In the control group, the mean age was 43.1 years (range, 35 to 50 years), the mean follow-up period was 21.8 months (range, 12 to 74 months), and bone union was observed at an average of 5.6 months (range, 4 to 12 months) after surgery. The difference in the time to bone union between the two groups was significant (p = 0.023). The union of grafted bone was obtained earlier in patients with AS than in those with degenerative spinal diseases. Therefore, future studies should examine the factors affecting the early union in AS patients

Changes of Serum Cytokines After the Long Term Immunotherapy with Japanese Hop Pollen Extracts

Japanese hop (Hop J) pollen has been considered as one of the major causative pollen allergens in the autumn season. We developed a new Hop J immunotherapy extract in collaboration with Allergopharma (Reinbeck, Germany) and investigated immunologic mechanisms during 3 yr immunotherapy. Twenty patients (13 asthma with rhinitis and 7 hay fever) were enrolled from Ajou University Hospital. Sera were collected before, 1 yr, and 3 yr after the immunotherapy. Changes of serum specific IgE, IgG1, and IgG4 levels to Hop J pollen extracts and serum IL-10, IL-12, TGFβ1 and soluble CD23 levels were monitored by ELISA. Skin reactivity and airway hyper-responsiveness to methacholine were improved during the study period. Specific IgG1 increased at 1 yr then decreased again at 3 yr, and specific IgG4 levels increased progressively (p<0.05, respectively), whereas total and specific IgE levels showed variable responses with no statistical significance. IL-10, TGF-β1 and soluble CD23 level began to decrease during first year and then further decreased during next two years with statistical significances. (p<0.05, respectively). In conclusion, these findings suggested the favorable effect of long term immunotherapy with Hop J pollen extracts can be explained by lowered IgE affinity and generation of specific IgG4, which may be mediated by IL-10 and TGF-β1