Juvenile idiopathic arthritis (JIA) comprises a group of heterogeneous disorders of chronic arthritis in childhood with no apparent etiology. Juvenile idiopathic arthritis is the most common pediatric rheumatic disease and is associated with significant long-term morbidity and mortality. There have been major advances in recent years in our understanding of the pathogenesis of JIA, the definition of disease control, and biological treatments for JIA. Multiple environmental and genetic factors have been linked with the onset and / or the exacerbation of JIA, including perinatal factors, viral and bacterial infections, epigenetic factors, and malnutrition. However, no single causative factor has been identified to date. As our understanding of the complex network of immune cells and inflammatory cytokines has improved, biologics have been developed to modulate the inflammatory processes. Indeed, a number of such biologics have been demonstrated effective for the treatment of JIA. Although biologic agents may alleviate the inflammation associated with JIA and prevent disability caused by joint destruction, continued and comprehensive observation is required to determine the long-term outcomes associated with such treatment.

The adhesion-class G protein-coupled receptors (adhesion- GPCRs) constitute the second largest GPCR sub-family in humans. Adhesion-GPCRs are defined by the chimeric structure of an unusually large extracellular cell-adhesion domain and a GPCR-like seven-pass transmembrane domain. Adhesion-GPCRs are hence expected to display both cellular adhesion and signaling functions in many biological systems. Adhesion-GPCRs are normally expressed in the central nervous, immune, and reproductive systems in a cell type- or tissue- restricted fashion. However, aberrant expression of distinct adhesion-GPCR molecules has been identified in various human cancers with some of the receptors closely associated with cancer development. Tumor-associated adhesion-GPCRs are thought to involve in tumorigenesis by affecting the growth of tumor cells, angiogenesis, tumor cell migration, invasion and metastasis either positively or negatively. Furthermore, some adhesion-GPCRs are considered potential biomarkers for specific types of cancers. In this review article, the expressional characteristics and functional role of cancer-associated adhesion-GPCRs are discussed in depth.

Background: Recently, tissue engineering has been introduced as a regenerative treatment for bone defects. There is some evidence showing bone regeneration from mesenchymal stem cells (MSC) loaded on hydroxyapatite β-tricalcium phosphate (HA/TCP) as a scaffold in large defects. This study aimed to compare the quality and quantity of regenerated bone using Bio-Oss, HA/TCP and MSC loaded HA/TCP scaffolds. Methods- Mesenchymal stem cells were aspirated from iliac crest bone marrow after extracting the first, second and third premolars and the first molar in five mature hybrid dogs. The cells were cultured and their osteogenic differentiation potential was evaluated after the third cell passage using Alizarin red staining in experimental conditions. The HA/TCP scaffold (3 x 3 x 3 mm) was loaded with undifferentiated mesenchymal stem cells. Bilateral bone defects were then prepared in the jaws using trephine burs. The defects were randomly filled with HA/TCP, Bio-Oss, or HA/TCP + MSCs. One defect served as a control and was left as an empty cavity. All defects except the control defect were covered with an absorbable membrane. Histological and histomorphometric evaluations were conducted after 6 weeks and data were subjected to analysis of variance (ANOVA) p < 0.05). Results - The empty cavity demonstrated more bone formation (60.80%) than the HA/TCP (44.93%) and Bio-Oss (40.60%) (p < 0.05) groups. However, the difference from the HA/TCP + MSCs group was not significant (46.38%) (p > 0.05). Conclusion - An MSC-loaded HA/TCP scaffold is a more effective alternative than Bio- OSS or HA/TCP in inducing bone regeneration.

Background: Acute painful scrotum is one of the most challenging urological emergencies. Irreversible parenchymal damage will develop if a testicle is twisted. The aim of the study was to determine the importance of different clinical clues to help differentiate the causes of this devastating condition. Methods: The medical charts of teenagers with acute scrotal pain between January 2003 and December 2008 were reviewed retrospectively. Results: Seventy-six patients were included in this study, including 47 initially suspected of having testicular torsion and 29 suspected of having epididymoorchitis. Testicular torsion was confirmed in 39 of the suspected 47 cases after surgical exploration. Twnety-one of these 39 testicular torsion patients underwent orchiectomy, and 18 were rescued and underwent orchiopexy. The mean pain duration was significantly longer in the orchiectomy group than the orchiopexy group (38.05 hours vs 14.14 hours, p = 0.009). In the testicular torsion group, fewer patients had elevated C-reactive protein levels no patients had pyuria, and the pain duration was shorter compared with the epididymo-orchitis group (5/11 vs 13/22 [p = 0.045], 0/28 vs 8/28 [p = 0.004] and 27.0 vs 74.5 hours [p = 0.0003], respectively). The sensitivity of color Dopper ultrasound in diagnosing testicular torsion and epididymo-orchitis was 84.09% vs 92.59%. Logistic regression for multivariate analysis showed that left side manifestation and pain duration were significantly different between testicular torsion and epididymo-orchitis with odds ratios of 4.76, p = 0.020 and 0.98, p = 0.029, respectively. Conclusions: Pain duration and left side manifestation are independent risk factors of testicular torsion. Prompt surgical exploration should be done if testicular torsion is highly suspected.

Background: A fluctuating blood glucose level is one of the risks of chronic complications in diabetes. Previous studies indicated that hemoglobin A1c (HbA1c) values apparently improved after initiation of self-monitoring blood glucose (SMBG). The purpose of this study is to investigate the relationship between the frequency of SMBG, long-term fluctuatation of HbA1c, and risks of chronic complications in diabetes. Methods: We enrolled 1052 patients with type 2 diabetes. The mean follow-up was 4.7 years. The HbA1c level and frequency of SMBG were recorded every 3 months. Non-mydriatic retinal photography, semiquantitative neuropathy assessment, the lipid profile, serum creatinine level, and urine protein were measured at the beginning of the study and then every year. The fluctuation in HbA1c throughout the period was expressed as the standard deviations (SDs) of all measurements of the HbA1c. Results: The frequency of SMBG was significantly and negatively correlated with the SDs of the HbA1c (r = -0.553, p < 0.001) but not with the average HbA1c. After controlling for age, sex, body mass index, duration of diabetes and comorbidities (dyslipidemia and hypertension), the correlation was still apparent (r = -0.511, p = 0.008). Patients with progression of nephropathy, neuropathy, and retinopathy, exhibited greater fluctuation of HbA1cs (2.38 ± 0.99 vs. 0.93 ± 1.16, p-value 0.002; 0.97 ± 1.59 vs. 0.90 ± 0.56, p value 0.04; 0.99 ± 1.33 vs. 0.90 ± 0.56, p-value 0.04, respectively) and less frequent SMBG (3.2 ± 2.6 vs. 4.3 ± 3.1, p-value 0.02; 3.2 ± 2.6 vs. 4.1 ± 3.9, p-value 0.05; 3.0 ± 3.1 vs. 4.2 ± 2.8, p-value 0.01, respectively) than patients without progression of these complications. Conclusion: This study shows that frequent SMBG decreased the fluctuation of HbA1c and decreased microvascular complications. Decreasing fluctuation of HbA1c may play an important role in diabetes treatment.

Background: The two-incision technique and the modified Watson-Jones technique use muscular intervals and avoid muscle cutting in total hip arthroplasty (THA). However these two techniques have not been compared. Methods: A prospective randomized study of clinical outcomes and patient preferences was performed in 20 patients who had a two-incision THA in one hip and a modified Watson-Jones THA in the other between January 2004 and August 2007. The 20 patients were randomized equally to the two-incision first or the modified Watson-Jones first group. After the second surgery, patients were asked about their preferences for one of the two techniques and clinical results were analyzed. Results: After a minimal follow-up of 2 years, there were no differences in the hospital course, clinical results, functional outcomes, and radiographic results between techniques. However more patients (70%) preferred the two-incision side to the modified Watson-Jones side in the first 6 months regardless which procedure was performed first. Conclusion: Given the similarity of these two techniques in cup implantation and with only a difference in femoral stem implantation, we think that the difference in patient preferences in the early postoperative period might be related to the surgical dissection and manipulation of the hip with the modified Watson-Jones technique.

Background: Salivary gland masses constitute a diagnostic challenge in daily clinical practice and tissue sampling is required to establish a diagnosis. We aimed to evaluate the efficacy of ultrasonography-guided fine needle aspiration biopsy (UGFNAB) in the diagnosis of salivary gland lesions. Methods: From January 2007 to September 2010, a total of 158 patients who underwent both UGFNAB and surgical excision for salivary gland mass lesions were included in this study. Patients with insufficient sampling or inconclusive cytology diagnosis were excluded from the analysis of diagnostic accuracy of UGFNAB. Results: UGFNAB yielded sufficient sampling for analysis in 137 patients, leading to a diagnostic yield of 86.7%. Among these 137 patients, 24 patients were confirmed to have malignant tumors. The sensitivity, specificity and accuracy of UGFNAB for malignancy were 66.7%, 98.2%, and 92.7%, respectively. No UGFNAB-related complications were encountered. Conclusions: UGFNAB of salivary gland masses is a safe technique that offers high specificity and accuracy but moderate diagnostic yield and sensitivity.

Background: Hepatic hemangiomas are the most common benign hepatic tumors, and they are usually asymptomatic with normal liver function. When hepatic hemangiomas reach 4 cm, we define them as giant hemangiomas. Treatment options for giant hemangiomas are observation, surgical resection, and transcatheter arterial embolization. The aim of this study was to identify the risk factors for surgical complications. Methods: In this study, the records of 61 patients with giant hepatic hemangiomas treated with surgical resection at Chang Gung Memorial Hospital, Linkou were retrospectively reviewed. Data on clinical variables including symptoms, the size, number, and location of the tumors, preoperative liver function tests, operative method, operation time, and operative blood loss were collected and analyzed. Results: There were 8 patients (13.1%, 95% confidence interval 5.8% to 24.2%) with complications after resection or enucleation. Postoperative complications were associated with large tumor size (p = 0.021) and tumors that were symptomatic (p = 0.017). In addition, complications were associated with greater use of intraoperative inflow control (p = 0.053), longer operative time (p = 0.001), and greater intraoperative blood loss (p = 0.022). Most complications could be treated conservatively, but invasive interventions such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangial drainage were required for management of grade III complications. Conclusions: Most giant hepatic hemangiomas can be treated with enucleation or resection. Important factors associated with complications were large tumor size, the presence of symptoms, surgical bleeding, and prolonged surgery. Most complications were grade I and could be treated conservatively. Both resection and enucleation were relatively safe with an acceptable complication rate (13.1%) and no mortality in our study.

Background: Hemoglobin variability in hemodialysis patients treated with erythropoiesisstimulating agents has been used to evaluate mortality and comorbidity. Different outcomes have been reported in American and European hemodialysis patients. There are, however, few studies of the effects of hemoglobin variability in peritoneal dialysis patients. Methods: We investigated hemoglobin variability in 363 peritoneal dialysis patients over 2 years to evaluate mortality and the association with comorbidity, peritonitis, and hospitalization. The hemoglobin of all patients selected for the study had been monitored for at least 6 months (April 2008 to September 2008). We assessed hemoglobin variability as fluctuations from the target hemoglobin level (11-12.5 g/dL). We defined the following 6 patient groups on the basis of hemoglobin patterns: consistently low (< 11 g/dL), consistently target range (11-12.5 g/dL), consistently high (> 12.5 g/dL), low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high amplitude fluctuation. Results: Only 2% of patients maintained a stable hemoglobin level within the target range and 46.8% of patients exhibited consistently low hemoglobin levels. After 2 years of observation, there was no difference in mortality as assessed by Kaplan-Meier analysis. There were also no differences in peritonitis and hospitalization between the 6 groups. However, the length of hospital stay was longer in the high amplitude fluctuation group (p = 0.008). Conclusion: Hemoglobin variability does not predict mortality in peritoneal dialysis patients.