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1.  Applicability and Safety of in Vitro Skin Expansion Using a Skin Bioreactor: A Clinical Trial 
Archives of Plastic Surgery  2014;41(6):661-667.
Tissue expansion is an effective and valuable technique for the reconstruction of large skin lesions and scars. This study aimed to evaluate the applicability and safety of a newly designed skin expanding bioreactor system for maximizing the graft area and minimizing the donor site area.
A computer-controlled biaxial skin bioreactor system was used to expand skin in two directions while the culture media was changed daily. The aim was to achieve an expansion speed that enabled the skin to reach twice its original area in two weeks or less. Skin expansion and subsequent grafting were performed for 10 patients, and each patient was followed for 6 months postoperatively for clinical evaluation. Scar evaluation was performed through visual assessment and by using photos.
The average skin expansion rate was 10.54%±6.25%; take rate, 88.89%±11.39%; and contraction rate, 4.2%±2.28% after 6 months. Evaluation of the donor and recipient sites by medical specialists resulted in an average score of 3.5 (out of a potential maximum of 5) at 3 months, and 3.9 at 6 months. The average score for patient satisfaction of the donor site was 6.2 (out of a potential maximum of 10), and an average score of 5.2 was noted for the recipient site. Histological examination performed before and after the skin expansion revealed an increase in porosity of the dermal layer.
This study confirmed the safety and applicability of the in vitro skin bioreactor, and further studies are needed to develop methods for increasing the skin expansion rate.
PMCID: PMC4228207  PMID: 25396177
Skin transplantation; Tissue expander devices; Cicatrix
2.  A Rare Case of Diffuse Pulmonary Lymphangiomatosis in a Middle-Aged Woman 
Korean Journal of Radiology  2014;15(2):295-299.
Diffuse pulmonary lymphangiomatosis (DPL) is a rare lymphatic disorder characterized by lymphatic channel proliferation. It is mostly reported in children and young adults. Here, we report a case involving a 52-year-old asymptomatic woman who presented with increased interstitial markings, as seen on a chest radiograph. Diffuse interstitial septal thickening was found on a serial follow-up chest computed tomography scan, and lymphangitic metastasis was the primary radiologic differential diagnosis. However, histologic sections of wedge resected lung revealed diffuse pleural and interlobular septal lymphatic proliferation characteristic of DPL.
PMCID: PMC3955798  PMID: 24642766
Lymphangiomatosis; Interstitial; Lung; Computed tomography
3.  Myogenic-induced mesenchymal stem cells are capable of modulating the immune response by regulatory T cells 
Journal of Tissue Engineering  2014;5:2041731414524758.
Cell therapy for patients who have intractable muscle disorders may require highly regenerative cells from young, healthy allogeneic donors. Mesenchymal stem cells are currently under clinical investigation because they are known to induce muscle regeneration and believed to be immune privileged, thus making them suitable for allogeneic applications. However, it is unclear whether allogeneic and myogenic-induced mesenchymal stem cells retain their immunomodulatory characteristics. Therefore, our aim was to evaluate the effects of mesenchymal stem cell differentiation on the immune characteristics of cells in vitro. We investigated the immunologic properties of mesenchymal stem cells after myogenic induction. Mesenchymal stem cells were obtained from C57BL/6 mice and the C3H/10T1/2 murine mesenchymal stem cell line. Two different 5-aza-2′-deoxycytidine doses (0.5 and 3 µM) were evaluated for their effects on mesenchymal stem cell skeletal myogenic differentiation potential, immune antigen expression, and mixed lymphocytic reactions. Using a mixed lymphocytic reaction, we determined the optimal splenocyte proliferation inhibition dose. The induction of regulatory T cells was markedly increased by the addition of 3 µM 5-aza-2′-deoxycytidine–treated mesenchymal stem cells. Myogenic-induced mesenchymal stem cells do not elicit alloreactive lymphocyte proliferative responses and are able to modulate immune responses. These findings support the hypothesis that myogenic-induced mesenchymal stem cells may be transplantable across allogeneic barriers.
PMCID: PMC3927963  PMID: 24555015
Mesenchymal stem cell; myogenic induction; immune modulation; regulatory T cells
4.  Interpretation of Digital Chest Radiographs: Comparison of Light Emitting Diode versus Cold Cathode Fluorescent Lamp Backlit Monitors 
Korean Journal of Radiology  2013;14(6):968-976.
To compare the diagnostic performance of light emitting diode (LED) backlight monitors and cold cathode fluorescent lamp (CCFL) monitors for the interpretation of digital chest radiographs.
Materials and Methods
We selected 130 chest radiographs from health screening patients. The soft copy image data were randomly sorted and displayed on a 3.5 M LED (2560 × 1440 pixels) monitor and a 3 M CCFL (2048 × 1536 pixels) monitor. Eight radiologists rated their confidence in detecting nodules and abnormal interstitial lung markings (ILD). Low dose chest CT images were used as a reference standard. The performance of the monitor systems was assessed by analyzing 2080 observations and comparing them by multi-reader, multi-case receiver operating characteristic analysis. The observers reported visual fatigue and a sense of heat. Radiant heat and brightness of the monitors were measured.
Measured brightness was 291 cd/m2 for the LED and 354 cd/m2 for the CCFL monitor. Area under curves for nodule detection were 0.721 ± 0.072 and 0.764 ± 0.098 for LED and CCFL (p = 0.173), whereas those for ILD were 0.871 ± 0.073 and 0.844 ± 0.068 (p = 0.145), respectively. There were no significant differences in interpretation time (p = 0.446) or fatigue score (p = 0.102) between the two monitors. Sense of heat was lower for the LED monitor (p = 0.024). The temperature elevation was 6.7℃ for LED and 12.4℃ for the CCFL monitor.
Although the LED monitor had lower maximum brightness compared with the CCFL monitor, soft copy reading of the digital chest radiographs on LED and CCFL showed no difference in terms of diagnostic performance. In addition, LED emitted less heat.
PMCID: PMC3835647  PMID: 24265575
Diagnostic radiology; Images; Display; Lung; Radiography; Nodule; Diffuse pulmonary disease
5.  Uncommon of the Uncommon: Malignant Perivascular Epithelioid Cell Tumor of the Lung 
Korean Journal of Radiology  2013;14(4):692-696.
A perivascular epithelioid cell (PEC) tumor is a rare mesenchymal tumor characterized by abundant cytoplasmic Periodic acid-Schiff positive glycogen (also called sugar tumor or clear cell tumor of the lung for this characteristic) and is mostly benign. We report a case of a 63-year-old man who presented with an enlarging mass on chest radiograph. After a thorough workup, diagnosis of malignant pulmonary PEC tumor with lung to lung metastases was established. Herein, the difficulties of diagnosis and management we confronted are described.
PMCID: PMC3725366  PMID: 23901329
Perivascular epithelioid cell; Pecoma; Clear cell sugar tumor; Lung tumor
6.  Human Amniotic Fluid Stem Cell-derived Muscle Progenitor Cell Therapy for Stress Urinary Incontinence 
Journal of Korean Medical Science  2012;27(11):1300-1307.
The most promising treatment for stress urinary incontinence can be a cell therapy. We suggest human amniotic fluid stem cells (hAFSCs) as an alternative cell source. We established the optimum in vitro protocol for the differentiation from hAFSCs into muscle progenitors. These progenitors were transplanted into the injured urethral sphincter and their therapeutic effect was analyzed. For the development of an efficient differentiation system in vitro, we examined a commercial medium, co-culture and conditioned medium (CM) systems. After being treated with CM, hAFSCs were effectively developed into a muscle lineage. The progenitors were integrated into the host urethral sphincter and the host cell differentiation was stimulated in vivo. Urodynamic analysis showed significant increase of leak point pressure and closing pressure. Immunohistochemistry revealed the regeneration of circular muscle mass with normal appearance. Molecular analysis observed the expression of a larger number of target markers. In the immunogenicity analysis, the progenitor group had a scant CD8 lymphocyte. In tumorigenicity, the progenitors showed no teratoma formation. These results suggest that hAFSCs can effectively be differentiated into muscle progenitors in CM and that the hAFSC-derived muscle progenitors are an accessible cell source for the regeneration of injured urethral sphincter.
PMCID: PMC3492662  PMID: 23166409
Amniotic Fluid; Stem Cells; Cell Differentiation; Urinary Sphincter; Regeneration; Urinary Incontinence
7.  Human amniotic fluid stem cell injection therapy for urethral sphincter regeneration in an animal model 
BMC Medicine  2012;10:94.
Stem cell injection therapies have been proposed to overcome the limited efficacy and adverse reactions of bulking agents. However, most have significant limitations, including painful procurement, requirement for anesthesia, donor site infection and a frequently low cell yield. Recently, human amniotic fluid stem cells (hAFSCs) have been proposed as an ideal cell therapy source. In this study, we investigated whether periurethral injection of hAFSCs can restore urethral sphincter competency in a mouse model.
Amniotic fluids were collected and harvested cells were analyzed for stem cell characteristics and in vitro myogenic differentiation potency. Mice underwent bilateral pudendal nerve transection to generate a stress urinary incontinence (SUI) model and received either periurethral injection of hAFSCs, periurethral injection of Plasma-Lyte (control group), or underwent a sham (normal control group).
For in vivo cell tracking, cells were labeled with silica-coated magnetic nanoparticles containing rhodamine B isothiocyanate (MNPs@SiO2 (RITC)) and were injected into the urethral sphincter region (n = 9). Signals were detected by optical imaging. Leak point pressure and closing pressure were recorded serially after injection.
Tumorigenicity of hAFSCs was evaluated by implanting hAFSCs into the subcapsular space of the kidney, followed two weeks later by retrieval and histologic analysis.
Flow activated cell sorting showed that hAFSCs expressed mesenchymal stem cell (MSC) markers, but no hematopoietic stem cell markers. Induction of myogenic differentiation in the hAFSCs resulted in expression of PAX7 and MYOD at Day 3, and DYSTROPHIN at Day 7. The nanoparticle-labeled hAFSCs could be tracked in vivo with optical imaging for up to 10 days after injection. Four weeks after injection, the mean LPP and CP were significantly increased in the hAFSC-injected group compared with the control group. Nerve regeneration and neuromuscular junction formation of injected hAFSCs in vivo was confirmed with expression of neuronal markers and acetylcholine receptor. Injection of hAFSCs caused no in vivo host CD8 lymphocyte aggregation or tumor formation.
hAFSCs displayed MSC characteristics and could differentiate into cells of myogenic lineage. Periurethral injection of hAFSCs into an SUI animal model restored the urethral sphincter to apparently normal histology and function, in absence of immunogenicity and tumorigenicity.
PMCID: PMC3520761  PMID: 22906045
urinary incontinence; amniotic fluid; stem cells
8.  Menopausal Symptom Experience of Hispanic Midlife Women in the U.S. 
Health care for women international  2009;30(10):919-934.
Using a feminist approach, we examined the menopausal symptom experience of Hispanic midlife women in the U.S. This was a qualitative online forum study among 27 Hispanic midlife women in the U.S. Seven topics related to menopausal symptom experience were used to administer the 6-month online forum. The data were analyzed using thematic analysis. Four themes were identified: (a) “Cambio de vida (change of life),” (b) “being silent about menopause,” (c) “trying to be optimistic,” and (d) “getting support.” More in-depth studies with diverse groups of Hispanic women are needed while considering family as a contextual factor.
PMCID: PMC2782818  PMID: 19742365
Hispanic; Midlife Women; Menopause; Symptoms
9.  A National Online Forum on Ethnic Differences in Cancer Pain Experience 
Nursing research  2009;58(2):86-94.
Cultural values and beliefs related to cancer and pain have been used to explain ethnic differences in cancer pain experience. Yet, very little is known about similarities and differences in cancer pain experience among different ethnic groups.
To explore similarities and differences in cancer pain experience among four major ethnic groups in the United States.
A feminist approach by Hall and Stevens was used. This was a cross-sectional qualitative study among 22 White, 15 Hispanic, 11 African American, and 27 Asian cancer patients recruited through both Internet and community settings. Four ethnic-specific online forums were conducted for 6 months. Nine topics related to cancer pain experience were used to guide the online forums. The collected data were analyzed using thematic analysis involving line-by-line coding, categorization, and thematic extraction.
All participants across ethnic groups reported “communication breakdowns” with their health care providers and experienced “changes in perspectives.” All of them reported that their cancer pain experience was “gendered experience.” White patients focused on how to control their pain and treatment selection process, while ethnic minority patients tried to control pain by minimizing and normalizing it. White patients sought out diverse strategies of pain management; ethnic minority patients tried to maintain normal lives and use natural modalities for pain management. Finally, the cancer pain experience of White patients was highly individualistic and independent, while that of ethnic minority patients was family-oriented.
These findings suggest that nurses need to use culturally competent approaches to cancer pain management for different ethnic groups. Also, the findings suggest further in-depth cultural studies on the pain experience of multiethnic groups of cancer patients.
PMCID: PMC2668932  PMID: 19289929
cancer; ethnic minority; experience; pain
10.  Characteristics of Cancer Patients in Internet Cancer Support Groups 
The purpose of this study was to describe characteristics of cancer patients who were attending Internet Cancer Support Groups (ICSGs) and to provide direction for future research. A total of 204 cancer patients were recruited through ICSGs by posting the study announcement on the websites of the ICSGs. The participants were asked to fill out Internet survey questionnaires on sociodemographic characteristics and health/disease status. The data were analyzed using descriptive and inferential statistics including t-tests, ANOVA, and chi-square tests. Findings indicate that cancer patients recruited through the ICSGs tended to be middle-aged, well-educated, female and middle class. The findings also indicate that there were significant differences in some characteristics according to gender and ethnicity. Based on the findings, some implications are suggested for future research using and developing the ICSGs.
PMCID: PMC2504028  PMID: 18000430
Internet Cancer Support Groups; Cancer Patients; Sociodemographic Characteristics
11.  Internet Communities for Recruitment of Cancer Patients into an Internet Survey: A Discussion Paper 
The purpose of this paper is to provide future directions for the usage of Internet communities (ICs) for recruitment of research participants based on issues raised in an Internet survey among 132 cancer patients. 317 general and 233 ethnic-specific Internet Cancer Support Groups and 1,588 ethnic-specific ICs were contacted to recruit cancer patients. Research staff recorded issues and wrote memos during the recruitment process. The written memos and records were later analyzed using content analysis. The issues included: (a) difficulty in identifying appropriate ICs and potential participants, (b) meta-tags, (c) dominant white and women groups, (d) dynamics inside ICs, (e) difficulty in trust building, and (f) potential selection bias. The findings suggest that researchers thoroughly review the ICs’ information, be recognizant of potential gender and ethnic issues and current trends in Internet interaction, and consider potential selection bias.
PMCID: PMC2235818  PMID: 16962122
Internet Communities; Cancer Patients; Recruitment; Internet Research

Results 1-11 (11)