Immunoglobulin G4-related disease (IgG4-RD) is a chronic, immune-mediated-, systemic disease that is characterized by IgG4 plasma cell infiltration with fibrotic changes in various organs. The most affected organs are pancreas and salivary glands. Kidney can be rarely involved, and is usually represented as a renal mass and organomegaly. Usually, elevated levels of serum IgG4 more than 135 mg/dl with organ-specific features and biopsy results showing enriched infiltration of IgG4-positive plasma cells are needed to diagnose the disease. However, we experienced two unusual cases of IgG4-RD involving kidney. IgG4-related kidney disease (IgG4-RKD) was first reported as an extra pancreatic feature of autoimmune pancreatitis(AIP) in 2004. Herein, we describe two cases of such unique presentation of IgG4RKD and a literature review focusing on clinicopathologic features of IgG4RKD. Our cases are distinct in the fact that IgG4RD invades unusual organs such as perinephric capsule or scrotum. We reported the patient who showed extinct perirenal capsule invasion with multi-organ involvement including exocrine glands in comparison to previous IgG4RKD that often involved in renal parenchyma and renal pelvis lesions. And the other patient had scrotal invasion with multifocal renal parenchymes. Referring to the features observed in these two cases, we could propose that as every organ can be related to IgG4RD, we propose clinicians to confirm the disease using imaging, serologic, and pathologic studies. We also reviewed previous reports of IgG4-RKD and summarized diverse imaging findings and pathologic features.
Coughing is one of the most important mechanisms performed in human body in that it removes mucus. The absence of enough ability to remove mucus leads to accumulation of the mucus on the airway, followed by possible complications such as pneumonia and atelectasis. Patients with diseases or disorders such as spinal cord injury have weakened ability in coughing. So far, there have been various treatments such as intubation surgery, mechanical insufflation-exsufflation or manual assistance provided by paramedic. But those treatments are mainly focusing on hospitalized patients. Patients showing better abilities in breathing are rarely and sporadically cared. We found that our prior research to assist breathing of these patients could also assist cough. Also, with our mechanism, now it is available that patients can care about themselves without on by own and more frequently if they needed assistance or treatment. To assist coughing, a belt-driven assistive robot are developed and effectiveness is investigated. With three healthy subjects, general breathing and coughing ability was monitored while using the robot. The result showed about 1.59 times better inhalation and exhalation. Also 1.52 times better coughing ability was measured.
To treat patients suffering from dysfunction of the abdominal muscles, positive pressure devices that can inject air directly into a patient's mouth have been developed. But injection of air requires blocking of a patient's mouth with an air mask or air hose, which causes the patient additional inconvenience in talking and in breathing with their own mouth. The Respiratory Rehabilitation and Assistance Robot was developed to provide ventilation assistance without hindering patients from talking and breathing with their own mouth. The basic principle of the robot is a negative pressure assistance, using an abdomen pressuring part to push the abdomen of the user and help the user to exhale. The robot is mainly manipulated with an attached joystick. But without an additional control routine to govern the amount of force applied when the joystick is moved, usability and safety issues occur. In this research, linear, logarithmic, and exponential profiles that modify the joystick trajectory were tested to advance maneuverability of the robot conditioning the joystick signal. Through experiments, we found that logarithmic profiles with certain shape factors improve both usability and safety.Useok Jeong is with the
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