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2.  Clinical Characteristics of Pruritus in Patients with Scalp Psoriasis and Their Relation with Intraepidermal Nerve Fiber Density 
Annals of Dermatology  2014;26(6):727-732.
Background
The scalp is frequently affected in psoriasis patients, and pruritus can adversely affect the quality of life of affected patients. Few studies have assessed pruritus in scalp psoriasis.
Objective
To determine the correlation among the clinical characteristics of pruritus, psoriasis scalp severity index (PSSI), and intraepidermal nerve fiber (IENF) density in psoriatic scalp lesions.
Methods
Eighty patients (53 men, 27 women; mean age, 46.4 years; mean PSSI, 19.9) with scalp psoriasis were evaluated by using the PSSI and the Leuven itch scale. Biopsies were obtained from the lesional and nonlesional skin of 19 patients (10 men, 9 women; mean age, 37.8 years; mean PSSI, 25.8). Immunofluorescence staining of protein gene product 9.5 was performed to determine the IENF density.
Results
Sixty-four patients (80%) complained of pruritus associated with scalp psoriasis, which negatively affected their quality of life to varying degrees. A moderate positive relation between PSSI score and pruritus intensity was identified (r=0.225 and p=0.044). The IENF density in psoriatic lesions was significantly higher than that in the nonlesional scalp (6.2±1.2 vs. 4.2±1.6, p<0.001). However, the correlations between IENF density and PSSI score, and IENF density and pruritus intensity were insignificant.
Conclusion
These results indicate that pruritus prevalence is high in patients with scalp psoriasis, and pruritus considerably influences the patients' daily lives and quality of life. In addition, high IENF density in psoriatic scalp lesions may play a role in the development of pruritus in scalp psoriasis.
doi:10.5021/ad.2014.26.6.727
PMCID: PMC4252670  PMID: 25473225
Nerve fibers; Pruritus; Psoriasis; Scale; Scalp dermatoses
4.  Delivery of bone morphogenetic protein-2 and substance P using graphene oxide for bone regeneration 
International Journal of Nanomedicine  2014;9(Suppl 1):107-116.
In this study, we demonstrate that graphene oxide (GO) can be used for the delivery of bone morphogenetic protein-2 (BMP-2) and substance P (SP), and that this delivery promotes bone formation on titanium (Ti) implants that are coated with GO. GO coating on Ti substrate enabled a sustained release of BMP-2. BMP-2 delivery using GO-coated Ti exhibited a higher alkaline phosphatase activity in bone-forming cells in vitro compared with bare Ti. SP, which is known to recruit mesenchymal stem cells (MSCs), was co-delivered using Ti or GO-coated Ti to further promote bone formation. SP induced the migration of MSCs in vitro. The dual delivery of BMP-2 and SP using GO-coated Ti showed the greatest new bone formation on Ti implanted in the mouse calvaria compared with other groups. This approach may be useful to improve osteointegration of Ti in dental or orthopedic implants.
doi:10.2147/IJN.S50742
PMCID: PMC4024979  PMID: 24872706
bone morphogenetic protein-2; bone regeneration; graphene oxides; stem cell recruitment; substance P
5.  Modulation of BMP-2-Induced Chondrogenic Versus Osteogenic Differentiation of Human Mesenchymal Stem Cells by Cell-Specific Extracellular Matrices 
Tissue Engineering. Part A  2012;19(1-2):49-58.
Bone morphogenetic protein-2 (BMP-2) is known to induce both osteogenic and chondrogenic commitment of human mesenchymal stem cells (hMSCs). However, factors influencing BMP-2-dependent chondrogenic and osteogenic differentiation have not been investigated. In this study, we demonstrated that extracellular microenvironments, in the form of cell-derived matrices, play important roles in determining the specific lineage commitment of hMSCs in the presence of BMP-2. Extracellular matrices (ECMs) derived from osteoblasts and chondrocytes were utilized to regulate cell differentiation. Osteogenic and chondrogenic differentiation of hMSCs cultured on the two different cell-derived ECMs were assessed by quantitative real-time–polymerase chain reaction, immunocytochemistry, and western blot analysis. To minimize the effects of the cell-adhesion proteins contained in serum on the ECMs, hMSCs were cultured in serum-free osteogenic or chondrogenic differentiation medium. Fibronectin-, collagen type I-, or collagen type II-coated substrates were utilized as ECM controls. The ECM specific to each cell type promoted lineage-specific commitment of hMSCs in the presence of BMP-2, that is, osteoblast- and chondrocyte-derived ECM promoted osteogenic and chondrogenic commitment, respectively. Therefore, cell-specific ECMs are capable of modulating the BMP-2-induced osteogenic and chondrogenic differentiation of hMSCs.
doi:10.1089/ten.tea.2012.0245
PMCID: PMC3530938  PMID: 23088504
6.  Enhanced Cartilage Formation via Three-Dimensional Cell Engineering of Human Adipose-Derived Stem Cells 
Tissue Engineering. Part A  2012;18(19-20):1949-1956.
Autologous chondrocyte implantation is an effective treatment for damaged articular cartilage. However, this method involves surgical procedures that may cause further cartilage degeneration, and in vitro expansion of chondrocytes can result in dedifferentiation. Adipose-derived stem cells (ADSCs) may be an alternative autologous cell source for cartilage regeneration. In this study, we developed an effective method for large-scale in vitro chondrogenic differentiation, which is the procedure that would be required for clinical applications, and the subsequent in vivo cartilage formation of human ADSCs (hADSCs). The spheroid formation and chondrogenic differentiation of hADSCs were induced on a large scale by culturing hADSCs in three-dimensional suspension bioreactors (spinner flasks). In vitro chondrogenic differentiation of hADSCs was enhanced by a spheroid culture compared with a monolayer culture. The enhanced chondrogenesis was probably attributable to hypoxia-related cascades and enhanced cell–cell interactions in hADSC spheroids. On hADSCs loading in fibrin gel and transplantation into subcutaneous space of athymic mice for 4 weeks, the in vivo cartilage formation was enhanced by the transplantation of spheroid-cultured hADSCs compared with that of monolayer-cultured hADSCs. This study shows that the spheroid culture may be an effective method for large-scale in vitro chondrogenic differentiation of hADSCs and subsequent in vivo cartilage formation.
doi:10.1089/ten.tea.2011.0647
PMCID: PMC3463274  PMID: 22881427
7.  Transplantation of Cord Blood Mesenchymal Stem Cells as Spheroids Enhances Vascularization 
Tissue Engineering. Part A  2012;18(19-20):2138-2147.
Despite promising results from the therapeutic use of stem cells for treating ischemic diseases, the poor survival of cells transplanted into ischemic regions is one of the major problems that undermine the efficacy of stem cell therapy. Cord blood mononuclear cells (CBMNCs) are an alternative source of mesenchymal stem cells (MSCs) without disadvantages, such as the painful and invasive harvesting procedure, of MSCs derived from bone marrow or adipose tissue. In the present study, we investigated whether the angiogenic efficacy of cord blood mesenchymal stem cells (CBMSCs) can be enhanced by grafting as spheroids in a mouse hindlimb ischemia model. Human CBMSC (hCBMSC) spheroids were prepared by using the hanging-drop method. Mouse hindlimb ischemia was induced by excising the femoral artery and its branches. After surgery, the animals were divided into no-treatment, dissociated hCBMSC, and spheroid hCBMSC groups (n=8 per group) and received corresponding hCBMSC treatments. After surgery, the ischemic hindlimbs were monitored for 4 weeks, and then, the ischemic hindlimb muscles were harvested for histological analysis. Apoptotic signaling, angiogenesis-related signal pathways, and blood vessel formation were investigated in vitro and/or in vivo. The transplantation of hCBMSCs as spheroids into mouse ischemic hindlimbs significantly improved the survival of the transplanted cells by suppressing apoptotic signaling while activating antiapoptotic signaling. Furthermore, the transplantation of hCBMSCs as spheroids significantly increased the number of microvessels and smooth muscle α-actin-positive vessels in the ischemic limbs of mice, and attenuated limb loss and necrosis. Human CBMNC can be considered an alternative source of MSC, and spheroid-based hCBMSC delivery can be considered a simple and effective strategy for enhancing the therapeutic efficacy of hCBMSCs.
doi:10.1089/ten.tea.2011.0640
PMCID: PMC3463282  PMID: 22559333
9.  Three-Dimensional Cell Grafting Enhances the Angiogenic Efficacy of Human Umbilical Vein Endothelial Cells 
Tissue Engineering. Part A  2011;18(3-4):310-319.
Despite the great potential of cell therapy for ischemic disease, poor cell survival after engraftment in ischemic tissue limits its efficacy. Here we tested a hypothesis that three-dimensionally grafted human umbilical vein endothelial cell (HUVEC) spheroids would exhibit improved angiogenic efficacy following transplantation into mouse ischemic limbs compared with HUVECs prepared by conventional two-dimensional monolayer culture. One day after surgical induction of hindlimb ischemia in athymic mice, HUVECs cultured in monolayer or HUVEC spheroids were transplanted intramuscularly into ischemic limbs. Four weeks after the treatment, in the spheroid HUVEC transplantation group, we observed increased hypoxia-inducible factor-1α expression, decreased apoptosis, and increased HUVEC survival in the ischemic tissue compared with the monolayer HUVEC transplantation group. Transplantation of HUVEC spheroids also resulted in enhanced and prolonged secretion of paracrine factors as well as enhanced expression of factors involved in the recruitment of circulating angiogenic progenitor cells. In summary, transplantation of HUVECs as spheroids enhanced cell survival, increased paracrine factor secretion, and showed a potential as a therapeutic method to treat ischemic tissue damages by promoting angiogenesis.
doi:10.1089/ten.tea.2011.0193
PMCID: PMC3267972  PMID: 21902465
10.  Long-term Angiogenesis Efficacy Using a Heparin-Conjugated Fibrin (HCF) Delivery System with HBM-MSCs 
Background and Objectives:
Heparin-conjugated fibrin (HCF) is suitable for the release and localization of bFGF. We analyzed the effects of a bFGF delivery system using HCF with human bone marrow-derived mesenchymal stem cells (HBM- MSCs) in a dog ischemic limb model.
Methods and Results:
Animals were divided into HBM-MSCs, HBM-MSCs+HCF, bFGF-HCF, and HBM-MSCs+ bFGF-HCF groups. A total of 1×107 HBM-MSCs were injected per animal, and the amount of bFGF was 1 mg per dog. Ischemic muscles were harvested at eight weeks and six months after injection of cells. The HBM-MSCs+ bFGF-HCF group exhibited decreased proportions of capillaries and arterioles six months after transplantation. However, there were more cells positive for the angiogenic factors, VEGF and PDGF, in the eight-week specimens compared with those harvested six months after transplantation.
Conclusions:
Our results demonstrated that a single injection of HBM-MSCs did not have significant long-term angiogenic effects; however, a bFGF delivery system using HCF exerted prolonged angiogenic effects when combined with HBM-MSCs.
PMCID: PMC3840984  PMID: 24298352
Angiogenesis; Ischemia; Heparin-conjugated fibrin; HBM-MSCs; Vascular disease
11.  Stimulation of Chondrogenic Differentiation of Mesenchymal Stem Cells 
The methods for cartilage repair have been studied so far, yet many of them seem to have limitations due to the low regenerative capacity of articular cartilage. Mesenchymal stem cell (MSC) has been suggested as an alternative solution to remedy this challenging problem. MSCs, which have extensive differentiation capacity, can be induced to differentiate into chondrocytes under specific conditions. Particularly, this review focused on the effects of growth factors, cell-to-cell interactions and biomaterials in chondrogenesis of MSCs. Appropriate stimulations through these factors are crucial in differentiation and proliferation of MSCs. However, use of MSCs for cartilage repair has some drawbacks and risks, such as expression of hypertrophy-related genes in MSCs-derived chondrocytes and consequent calcification or cell death. Nevertheless, the clinical application of MSCs is expected in the future with advanced technology.
PMCID: PMC3840987  PMID: 24298351
Mesenchymal stem cell; Chondrogenesis; Growth factor; Cellular interaction; Biomaterial
12.  Parry-Romberg Syndrome with En Coup de Sabre 
Annals of Dermatology  2011;23(3):342-347.
Parry-Romberg syndrome (PRS) is a relatively rare degenerative disorder that is poorly understood. PRS is characterized by slowly progressing atrophy affecting one side of the face, and is frequently associated with localized scleroderma, especially linear scleroderma, which is known as en coup de sabre. This is a report of the author's experiences with PRS accompanying en coup de sabre, and a review of the ongoing considerable debate associated with these two entities. Case 1 was a 37-year-old woman who had right hemifacial atrophy with unilateral en coup de sabre for seven years. Fat grafting to her atrophic lip had been conducted, and steroid injection had been performed on the indurated plaque of the forehead. Case 2 was a 29-year-old woman who had suffered from right hemifacial atrophy and bilateral en coup de sabre for 18 years. Surgical corrections such as scapular osteocutaneous flap and mandible/maxilla distraction showed unsatisfying results.
doi:10.5021/ad.2011.23.3.342
PMCID: PMC3162264  PMID: 21909205
Encoup de sabre; Hemifacial atrophy; Parry-Romberg syndrome
13.  Efficacy of Piroxicam Patch Compared to Lidocaine Patch for the Treatment of Postherpetic Neuralgia 
Annals of Dermatology  2011;23(2):162-169.
Background
The lidocaine patch has been effectively used as a first-line therapy to treat neuropathic pain such as postherpetic neuralgia (PHN).
Objective
To evaluate the safety and efficacy of the topical piroxicam patch as a treatment option for the treatment of PHN.
Methods
Eighteen patients completed a 3-session study, applying three different patches (lidocaine, piroxicam and control) in random order. A maximum of three patches were applied to the most painful area for three consecutive days (12 hours on followed by 12 hours off). Each session was conducted at least seven days apart. The changes in visual analog scale (VAS) scores based pain intensity, quality of sleep and adverse effects were recorded.
Results
When compared to the control, both the lidocaine and piroxicam patches significantly reduced the mean VAS scores of pain intensity of all different types. However, the lidocaine patch was better at reducing allodynia, whereas the piroxicam patch was more effective for dull pain. The lidocaine patch worked faster than the piroxicam patch for the response to overall pain relief.
Conclusion
The results of this study suggest the use of the piroxicam patch for dull pain and in patients where the lidocaine patch is contraindicated.
doi:10.5021/ad.2011.23.2.162
PMCID: PMC3130858  PMID: 21747614
Allodynia; Dull pain; Lidocaine patch; Piroxicam patch; Postherpetic neuralgia
14.  Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient 
Journal of Korean Medical Science  2011;26(3):450-453.
Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.
doi:10.3346/jkms.2011.26.3.450
PMCID: PMC3051097  PMID: 21394318
Alcohol; Bullae and Sweat Gland Necrosis; Sweat Glands; Vibrio vulnificus infection
15.  Stemness Evaluation of Mesenchymal Stem Cells from Placentas According to Developmental Stage: Comparison to Those from Adult Bone Marrow 
Journal of Korean Medical Science  2010;25(10):1418-1426.
This study was done to evaluate the stemness of human mesenchymal stem cells (hMSCs) derived from placenta according to the development stage and to compare the results to those from adult bone marrow (BM). Based on the source of hMSCs, three groups were defined: group I included term placentas, group II included first-trimester placentas, and group III included adult BM samples. The stemness was evaluated by the proliferation capacity, immunophenotypic expression, mesoderm differentiation, expression of pluripotency markers including telomerase activity. The cumulative population doubling, indicating the proliferation capacity, was significantly higher in group II (P<0.001, 31.7±5.8 vs. 15.7±6.2 with group I, 9.2±4.9 with group III). The pattern of immunophenotypic expression and mesoderm differentiation into adipocytes and osteocytes were similar in all three groups. The expression of pluripotency markers including ALP, SSEA-4, TRA-1-60, TRA-1-81, Oct-4, and telomerase were strongly positive in group II, but very faint positive in the other groups. In conclusions, hMSCs from placentas have different characteristics according to their developmental stage and express mesenchymal stemness potentials similar to those from adult human BMs.
doi:10.3346/jkms.2010.25.10.1418
PMCID: PMC2946649  PMID: 20890420
Stemness; Placenta; Bone Marrow; Mesenchymal Stem Cells
16.  A Case of Xanthoma Disseminatum Accentuating over the Eyelids 
Annals of Dermatology  2010;22(3):353-357.
Xanthoma disseminatum (XD) is a rare, benign non-familial mucocutaneous disorder, which is a subset of non-Langerhans cell histiocytosis. It is characterized by mucocutaneous xanthomas in a disseminated form typically involving the eyelids, trunk, face, and proximal extremities and occurs in flexures and folds such as axillae and the groin. Mucosal involvement of the respiratory or gastrointestinal tracts may lead to hoarseness or intestinal obstruction from a mechanical mass effect. This paper outlines the case of a 47-year-old female with progressive yellow-to-brown confluent nodules and plaques of various sizes on her scalp, face, oral mucosa, neck, shoulder, axillary folds, and perianal area. Xanthomas accentuating over the eyelids and eyelashes led to partial obstruction of her visual field and interfered with blinking. Further, she suffered from xerophthalmia. The presentation of histopathological features including foamy histiocytes, inflammatory cells, and Touton giant cells in conjunction with her clinical findings indicated a diagnosis of XD. Evaluations for extracutaneous involvement including the central nervous system, respiratory tract, gastrointestinal tract, and bone resulted in nonspecific findings. Although she has been treated with surgical excisions, CO2 laser therapy, and oral prednisolone, new lesions are still emerging.
doi:10.5021/ad.2010.22.3.353
PMCID: PMC2917696  PMID: 20711279
Blinding; Field of vision; Xanthoma disseminatum; Xerophthalmia
17.  Modulation of Stem Cell Differentiation with Biomaterials 
Differentiation of stem cells can be controlled with interactions with microenvironments of the stem cells. The interactions contain various signals including soluble growth factor signal, cell adhesion signal, and mechanical signal, which can modulate differentiation of stem cells. Biomaterials can provide these types of signals to induce desirable cellular differentiation. Biomaterials can deliver soluble growth factors locally to stem cells at a controlled rate for a long period. Stem cell adhesion to specific adhesion molecules presented by biomaterials can induce specific differentiation. Mechanical signals can be delivered to stem cells seeded onto biomaterial scaffolds. These approaches would be invaluable for direction of stem cell differentiation and in vivo tissue regeneration using stem cells.
PMCID: PMC4021801  PMID: 24855545
Biomaterial; Differentiation; Growth factor; Scaffold; Stem cells
18.  Mesenchymal Stem Cells for Treatment of Myocardial Infarction 
Cardiovascular diseases including myocardial infarction are one of the major causes of adult mortality. Several treatments such as pharmacological therapy and heart transplantation have been used for the diseases, but the treatments have drawbacks. Therefore, cell-based myocardial therapies have received proper medical attention. Bone marrow stem cell (BMSC) including mesenchymal stem cell (MSC) and hematopoietic stem cell (HSC) is a potential source for cell therapy for heart diseases due to the ability of BMSC to differentiate into cell in cardiac tissue including cardiomyocyte and vascular endothelial cell. This article reviews the use of BMSCs for cardiovascular disease and the differentiation of BMSCs into cardiaomyocytes.
PMCID: PMC4021775  PMID: 24855508
Mesenchymal stem cell; Myocardial infarction; Differentiation; Cardiomyocyte
19.  A Case of Post-Streptococcal Glomerulonephritis with Diffuse Alveolar Hemorrhage 
Journal of Korean Medical Science  2007;22(6):1074-1078.
Acute post-streptococcal glomerulonephritis (PSGN) is characterized by an abrupt onset of edema, hypertension, and hematuria. Life-threatening diffuse alveolar hemorrhage (DAH) is rarely associated with acute PSGN. There have been only two reported cases worldwide, and no case has been reported previously in Korea. Here, we present a patient who clinically presented with pulmonary-renal syndrome; the renal histology revealed post-infectious glomerulonephritis of immune complex origin. A 59-yr-old woman was admitted with oliguria and hemoptysis two weeks after pharyngitis. Renal insufficiency rapidly progressed, and respiratory distress developed. Chest radiography showed acute progressive bilateral pulmonary infiltrates. The clinical presentation suggested DAH with PSGN. Three days after treatment with high-dose steroids, the respiratory distress and pulmonary infiltrates resolved. Electron microscopy of a renal biopsy specimen sample revealed diffuse proliferative glomerulonephritis with characteristic subendothelial deposits of immune complex ("hump"). The renal function of the patient was restored, and the serum creatinine level was normalized after treatment.
doi:10.3346/jkms.2007.22.6.1074
PMCID: PMC2694628  PMID: 18162726
Post-Streptococcal Glomerulonephritis; Diffuse Alveolar Hemorrhage
20.  Hematopoietic Differentiation of Embryoid Bodies Derived from the Human Embryonic Stem Cell Line SNUhES3 in Co-culture with Human Bone Marrow Stromal Cells 
Yonsei Medical Journal  2005;46(5):693-699.
Human embryonic stem (ES) cells can be induced to differentiate into hematopoietic precursor cells via two methods: the formation of embryoid bodies (EBs) and co-culture with mouse bone marrow (BM) stromal cells. In this study, the above two methods have been combined by co-culture of human ES-cell-derived EBs with human BM stromal cells. The efficacy of this method was compared with that using EB formation alone. The undifferentiated human ES cell line SNUhES3 was allowed to form EBs for two days, then EBs were induced to differentiate in the presence of a different serum concentration (EB and EB/high FBS group), or co-cultured with human BM stromal cells (EB/BM co-culture group). Flow cytometry and hematopoietic colony-forming assays were used to assess hematopoietic differentiation in the three groups. While no significant increase of CD34+/CD45- or CD34+/CD38- cells was noted in the three groups on days 3 and 5, the percentage of CD34+/CD45- cells and CD34+/CD38- cells was significantly higher in the EB/BM co-culture group than in the EB and EB/high FBS groups on day 10. The number of colony-forming cells (CFCs) was increased in the EB/BM co-culture group on days 7 and 10, implying a possible role for human BM stromal cells in supporting hematopoietic differentiation from human ES cell-derived EBs. These results demonstrate that co-culture of human ES-cell-derived EBs with human BM stromal cells might lead to more efficient hematopoietic differentiation from human ES cells cultured alone. Further study is warranted to evaluate the underlying mechanism.
doi:10.3349/ymj.2005.46.5.693
PMCID: PMC2810577  PMID: 16259069
Embryonic stem cells; embryoid body; differentiation
21.  Efficacy of 5% Imiquimod Cream on Vulvar Intraepithelial Neoplasia in Korea: Pilot Study 
Annals of Dermatology  2015;27(1):66-70.
Background
Various therapeutic options, including surgery, electrocautery, cryotherapy, 5-fluorouracil treatment, laser therapy, radiotherapy, photodynamic therapy, and interferon-α/γ injection, have been employed to treat vulvar intraepithelial neoplasia (VIN) with varying degrees of success. To truly cure VIN, human papillomavirus elimination is considered important.
Objective
To investigate the efficacy of 5% imiquimod cream used to treat VIN in Korean patients
Methods
We performed a prospective, uncontrolled, observational study. Nine patients with histologically confirmed VIN applied 5% imiquimod cream to their vulvar lesions three to five times a week until a clinical response was apparent. All lesions were photo-documented, and therapeutic efficacy was assessed in terms of local adverse effects lesion number, size, and hyperpigmentation.
Results
The mean treatment duration was 30.2 months, and the median follow-up period after therapy completion was 30 months. Of the nine patients recruited, six (66.6%) experienced complete responses (CR) or partial responses (PR). Hyperpigmented patches in the VIN lesions were evident in five subjects (55.6%), and all experienced either CR or PR. Only three patients (33.3%) suffered from local adverse effects, which were relieved after temporary suspension of therapy, and better outcomes were attained ultimately.
Conclusion
The imiquimod cream was more efficacious when used to treat VIN of the hyperpigmented type compared with lesions lacking pigmentation. The unifocal nature of a lesion and the development of local adverse effects are useful factors when imiquimod cream is prescribed. However, although the cream is convenient and effective, regional resistance may develop, and close follow-up is essential because VIN may become malignant.
doi:10.5021/ad.2015.27.1.66
PMCID: PMC4323605
Hyperpigmentation; Imiquimod; Vulvar intraepithelial neoplasia
22.  Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy for diffuse large B-cell lymphoma in pregnancy may be associated with preterm birth 
Obstetrics & Gynecology Science  2014;57(6):526-529.
Lymphoma, especially non-Hodgkin's lymphoma is extremely rare in pregnancy. A 24-year-old pregnant woman was diagnosed with diffuse large B-cell lymphoma (DLBCL), a subgroup of non-Hodgkin's lymphoma, at 24 weeks' gestation, and was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. After 4 cycles of R-CHOP, she delivered a healthy baby via cesarean section at 34 weeks and 5 days' gestation because of preterm contraction-related fetal distress. The patient was administered the remaining 2 cycles of R-CHOP after delivery. Follow-up magnetic resonance imaging and computed tomography showed complete remission. Here, we report a rare case of DLBCL successfully treated with R-CHOP chemotherapy during pregnancy, we also performed a systematic review of literature for similar cases. There were 3 earlier reports of R-CHOP treatment for DLBCL. All cases, including our case, resulted in preterm birth. Together, these findings suggest that R-CHOP chemotherapy for DLBCL in pregnancy may be associated with preterm birth.
doi:10.5468/ogs.2014.57.6.526
PMCID: PMC4245348  PMID: 25469343
Chemotherapy; Diffuse large B-cell lymphoma; Pregnancy; Preterm birth; R-CHOP
23.  A Phase II Study of Ifosfamide, Methotrexate, Etoposide, and Prednisolone for Previously Untreated Stage I/II Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type: A Multicenter Trial of the Korean Cancer Study Group 
The Oncologist  2014;19(11):1129-1130.
Background.
Combination chemotherapy consisting of ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) was active as first-line and second-line treatment for extranodal natural killer/T-cell lymphoma (NTCL).
Methods.
Forty-four patients with chemo-naïve stage I/II NTCL were enrolled in a prospective, multicenter, phase II study and received six cycles of IMEP (ifosfamide 1.5 g/m2 on days 1–3; methotrextate 30 mg/m2 on days 3 and 10; etoposide 100 mg/m2 on days 1–3; and prednisolone 60 mg/m2 per day on days 1–5) followed by involved field radiotherapy (IFRT).
Results.
Overall response rates were 73% (complete remission [CR] in 11 of 41 evaluable patients [27%]) after IMEP chemotherapy and 78% (CR 18 of 27 evaluable patients [67%]) after IMEP followed by IFRT. Neutropenia and thrombocytopenia were documented in 33 patients (75%) and 7 patients (16%), respectively. Only 8 patients (18%) experienced febrile neutropenia. Three-year progression-free survival (PFS) and overall survival (OS) were 66% and 56%, respectively. High Ki-67 (≥70%) and Ann Arbor stage II independently reduced PFS (p = .004) and OS (p = .001), respectively.
Conclusion.
Due to the high rate of progression during IMEP chemotherapy, IFRT needs to be introduced earlier. Moreover, active chemotherapy including an l-asparaginase-based regimen should be use to reduce systemic treatment failure in stage I/II NTCL.
doi:10.1634/theoncologist.2014-0305
PMCID: PMC4221378  PMID: 25280488
24.  Benefits of a Continuous Ambulatory Peritoneal Dialysis (CAPD) Technique with One Icodextrin-Containing and Two Biocompatible Glucose-Containing Dialysates for Preservation of Residual Renal Function and Biocompatibility in Incident CAPD Patients 
Journal of Korean Medical Science  2014;29(9):1217-1225.
In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Δ1.2±2.9 mL/min/1.73 m2, P=0.027) and urine volume (-Δ363.6±543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Δ0.5±2.7 mL/min/1.73 m2, P=0.266; -Δ108.6±543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, β2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]
Graphical Abstract
doi:10.3346/jkms.2014.29.9.1217
PMCID: PMC4168174  PMID: 25246739
Biocompatibility; Peritoneal Dialysis, Continuous Ambulatory; Icodextrin, Randomized Controlled Trial; Residual Renal Function
25.  Basal Cell Carcinoma-Mimicking Lesions in Korean Clinical Settings 
Annals of Dermatology  2014;26(4):431-436.
Background
Basal cell carcinoma (BCC) is the most common form of skin cancer and possesses various clinical features including translucency, ulceration, pigmentation, telangiectasia, and rolled borders. Accordingly, many cutaneous lesions can mimic BCCs and differential diagnosis is difficult.
Objective
To clarify the differences in clinical characteristics between BCCs and BCC-mimicking lesions (BMLs), and to determine which clinical characteristics are helpful for an accurate clinical diagnosis of BCC.
Methods
We performed clinicopathologic analysis of cutaneous lesions that received a clinical diagnosis of BCC. All lesions included in this study showed more than one of the following characteristics of BCCs: translucency, ulceration, flecked pigmentation, black or blue hue, telangiectasia, and rolled borders. We compared six clinical characteristics between the BCC group and the BML group.
Results
Among 48 lesions in the BML group, there were 15 premalignant or malignant lesions and 33 benign lesions. Various dermatoses mimicking BCC that have not been reported in the dermatological literature were identified, including angiosarcoma, vulvar intraepithelial neoplasm, foreign body granuloma, intravascular papillary endothelial hyperplasia, sarcoidosis, and others. Compared to the BML group, the BCC group had a significantly higher frequency of translucency (76.3% vs. 52.1%, p<0.001), ulceration or erosion (44.2% vs. 27.1%, p=0.022), black or blue hue (40.0% vs. 22.9%, p=0.020), and rolled borders (49.5% vs. 14.6%, p<0.001). Cutaneous lesions with two or less clinical features of BCC were significantly more likely to be BMLs.
Conclusion
The results of this study could be helpful for the differential diagnosis of BCCs and BCC-mimicking cutaneous lesions.
doi:10.5021/ad.2014.26.4.431
PMCID: PMC4135096  PMID: 25143670
Basal cell carcinoma; Differential diagnosis; Mimicking

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