Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain:A retrospective case series of single center experience

BACKGROUND Osteomalacia(OM)is frequently confused with various musculoskeletal or other rheumatic diseases,especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations.AIM To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM.METHODS A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic(spine and musculoskeletal pain clinic)primarily presenting with widespread musculoskeletal pain at a single tertiary hospital between January 2011 and December 2019.We enrolled patients with hypophosphatemia,high serum bone-specific alkaline phosphatase levels,and at least one imaging finding suggestive of OM.RESULTS Eight patients with adult-onset hypophosphatemic OM were included.The back was the most common site of pain.Proximal dominant symmetric muscle weakness was observed in more than half of the patients.Bone scintigraphy was the most useful imaging modality for diagnosing OM because radiotracer uptake in OM showed characteristic patterns.Six patients were diagnosed with adefovir(ADV)-induced Fanconi syndrome,and the other two patients were diagnosed with tumor-induced OM and light-chain nephropathy,respectively.After phosphorus and vitamin D supplementation and treatment for the underlying etiologies,improvements in pain,muscle strength,and gait were observed in all patients.CONCLUSION Mechanical pain characteristics,hypophosphatemia,and distinctive bone scintigraphy patterns are the initial diagnostic indicators of adult-onset hypophosphatemic OM.ADV-induced Fanconi syndrome is the most common etiology of hypophosphatemic OM in hepatitis B virus-endemic countries.

Fabrication of Transparent Conducting Electrode Pattern by Metal Mesh Method on Stretchable Film Substrate

Smart phones have become one of major electronic devices for human being. The easy and rapid exchange of information between man and machine is carried out by the touch screen panel (TSP) installed in the smart phones. Currently the smart phones are widely spread out while displays for automobiles are in the initial stage of developments. Since the automobile displays should fit the curved area of indoor space of the vehicle, the TSPs for automobiles need to be fabricated on the flexible and stretchable substrate film. In this study, we selected the thermo-plastic polyurethane film as the substrate film and examined the materials and process for fabrication of metal mesh type transparent conducting electrode films suitable for TSPs of automobile displays. The optimum UV resin system was established by the evaluation of various UV resin formulations in the UV imprinting process to make 3 × 3.5 μm trench patterns on the metal mesh type electrode film utilizing the embossed metal mask plate. The Ag paste has also been prepared by synthesis of Ag nanoparticles and formulation with the binder polymers. The inlay (filling) of Ag paste in the trench layer of transparent electrode film showed that the variation of electrical resistance was within 10% upon bending up to 100,000 times to radius of 3 mm.