YKL-40, a chitinase-3-like protein 1 (CHI3L1) or human cartilage glycoprotein 39 (HC gp-39), is expressed and secreted by various cell-types including macrophages, chondrocytes, fibroblast-like synovial cells and vascular smooth muscle cells. Its biological function is not well elucidated, but it is speculated to have some connection with inflammatory reactions and autoimmune diseases. Although having important biological roles in autoimmunity, there were only attempts to elucidate relationships of YKL-40 with a single or couple of diseases in the literature. Therefore, in order to analyze the relationship between YKL-40 and the overall diseases, we reviewed 51 articles that discussed the association of YKL-40 with rheumatoid arthritis, psoriasis, systemic lupus erythematosus, Behçet disease and inflammatory bowel disease. Several studies showed that YKL-40 could be assumed as a marker for disease diagnosis, prognosis, disease activity and severity. It is also shown to be involved in response to disease treatment. However, other studies showed controversial results particularly in the case of Behçet disease activity. Therefore, further studies are needed to elucidate the exact role of YKL-40 in autoimmunity and to investigate its potential in therapeutics.

BackgroundRecently, porous acupuncture (PA), which is anodized to increase its surface area for higher stimulation intensity, was developed and showed significantly improved therapeutic effects with more comfort as compared with original acupuncture (OA) in vivo. However, the impact of PA on the change of local blood flow as well as its efficacy and acceptability has not yet been confirmed in a clinical trial. In a randomized, controlled crossover clinical trial, we investigated the effects of PA on the change in local blood flow using laser Doppler perfusion imaging and considered the sensation of pain intensity and discomfort severity using a visual analogue scale (VAS) to explore its physiological impact and the possibility of PA in clinical use.MethodsTwenty-one healthy participants were randomly treated with PA or OA on one side of Zusanli (ST36) and each participant served as his or her own control. Baseline local blood flow and galvanic skin response (GSR) were obtained for 5 min and acupuncture interventions were subsequently performed. Next, local blood flow and GSR were subsequently obtained for 10 min after insertion, 10 min after manipulation, and 5 min after the withdrawal of acupuncture. At the end of the experiment, participants were asked to indicate the sensation of pain intensity at each session of insertion, retention, manipulation, and withdrawal as well as the overall pain intensity and discomfort severity.ResultsPA significantly increased the local blood flow as compared with OA and there was no significant difference in GSR between patients treated with PA versus OA in each phase of insertion and manipulation. No significant difference in pain intensity or discomfort severity was found during manipulation, retention, or withdrawal of acupuncture.ConclusionsThese results indicate that PA increases local blood flow, which can be closely related to the observed enhanced performance, without any associated discomfort or pain, suggesting its applicability in clinical practice.

EduTech (Education and Technology) has drawn great attention in improving education efficiency for non-face-to-face learning and practice. This paper introduced a blended gross anatomy class using both virtual reality (VR) devices and traditional programs alongside a practice-based cadaver dissection and in-class observation. The class allowed the students to get hands-on experience with both practical practice and VR operations to identify the biochemical aspects of the disease-induced internal organ damage as well as to view the three-dimensional (3D) aspect of human structures that cannot be practiced during the gross anatomy practice. Student surveys indicated an overall positive experience using VR education (satisfaction score over 4 out of 5, Likert scale question). There remains room for improvement, and it was discussed with the results of the essay-based question survey. Formative evaluation results showed that the students who trained in blended anatomy classes with VR set-ups received higher scores (85.28 out of 100, average score) than only cadaver-based anatomy class (79.06 out of 100, average score), and this result represents that the hybrid method could improve the academic efficiency and support the understanding of the 3D structure of the body. At present, VR cannot totally replace actual cadaver dissection practice, but it will play a significant role in the future of medical education if both students and practitioners have more VR devices, practice time, and a more intuitive user-friendly VR program. We believe that our paper will greatly benefit the development of EduTech and a potential new curriculum item for future medical education.

No abstract