Features of colonic diverticulitis in children and adolescents: A multicenter study

BACKGROUND

Colonic diverticulitis (CD), typically seen in the elderly of Western countries, is increasingly prevalent worldwide, yet data on CD in children and adolescents are scarce. This study explores the characteristics of CD in this younger demographic.

METHODS

In a multicenter, retrospective review, 104 patients under 20 years diagnosed with CD at four Korean tertiary hospitals from June 2003 to December 2020 were analyzed. Abdominal CT scans were used for diagnosis, with the modified Hinchey classification assessing the severity of CD.

RESULTS

CD was found in the cecum or ascending colon in 103 (99%) of cases. The mean patient age was 17.24 ± 2.4 years, with males constituting 59.6% of cases. Solitary lesions were noted in 93 (89.4%) of patients. Severity was classified as modified Hinchey stage 0 in 58.7%, stage Ia in 29.8%, and stage Ib in 11.5%, with no cases of stage II or higher. Misdiagnosis as acute appendicitis occurred in six instances. IV antibiotics were administered to 68.3%, and oral antibiotics were sufficient for 24%. Surgical treatment was necessary for two patients. A 7.8% recurrence rate was noted among first-time CD patients, yet all cases were amenable to conservative management.

CONCLUSION

While uncommon, CD in children and adolescents is a growing concern, with most cases presenting as solitary lesions in the cecum or ascending colon. The severity is typically less than that in adults, and conservative treatment is generally effective. These findings underscore the need for specific management guidelines for pediatric CD, advocating for non-surgical initial approaches.

Study on transient photocurrent induced by energy level defect of schottky diode irradiated by high power pulsed laser

The transient photocurrent is one of the key parameters of the spatial radiation effect of photoelectric devices, and the energy level defect affects the transient photocurrent. In this paper, by studying the deep level transient spectrum of a self-designed Schottky diode, the defect properties of the interface region of the anode metal AlCu and Si caused by high-temperature annealing at 150 ℃, 200 ℃ and 300 ℃ for 1200 h have been quantitatively analyzed. The study shows that the defect is located at the position of + 0.41 eV on the valence band, the concentration is 2.8 [Formula: see text] 1013/cm2, and the capture cross section is [Formula: see text] = 8.5 [Formula: see text] 1017. The impurity energy level mainly comes from the diffusion of Al atom in anode metal. We found that the defect did not cause the electrical performance degradation and obvious morphology change of the device, but the transient photocurrent increased significantly. The reason is that the high temperature treatment results in a growth in the density of states at the interface between AlCu-Si. The more mismatched dislocations and recombination center increased the reverse current of the heterojunction. The above view is proved by the TCAD simulation test.

Clinical course in children with equivocal appendicitis on computed tomography: a retrospective cohort study

Purpose

Appendectomy is one of the most common surgeries in children. Although various radiological examinations are performed, they do not always reveal a definitive diagnosis of appendicitis. This study aimed to investigate the clinical course of equivocal appendicitis, identify the factors associated with appendectomy, and suggest appropriate management for these patients.

Methods

Patients younger than 19 years who visited Seoul National University Bundang Hospital with a differential diagnosis of appendicitis from January 2013 to December 2017 were included. All participants conducted 'appendiceal CT' with a scoring scale of 1-5. The higher the score, the higher the likelihood of a radiologic diagnosis of appendicitis. We defined the appendicitis CT score of 2-4 as equivocal appendicitis (n = 143). Medical records were reviewed retrospectively for demographics, further examination as abdominal ultrasonography, and appendectomy status (yes or no). The mean follow-up period was 15.6 ± 71 days.

Results

Equivocal appendicitis accounted for 16.7%. Additional ultrasonography test was performed in 24.5% (35 of 143). In total, 34 patients (23.8%) underwent appendectomy. Among the patients with appendiceal CT scores 2, 3, and 4, 4.9%, 50.0%, and 87.5% underwent appendectomy, respectively. Higher WBC count, higher appendicitis CT score, and readmission were significantly associated with appendectomy in patients with equivocal appendicitis.

Conclusion

Higher appendicitis CT score and WBC level were positively associated with appendectomy. Careful observation can be a treatment option in appendicitis CT score 2 or 3 groups. Appendectomy is the first-line treatment for patients with appendicitis score 4. Additional ultrasonography test is advisable to determine treatment modality for equivocal appendicitis.

Identification of a candidate gene responsible for the G locus determining chartreuse bulb color in onion (Allium cepa L.) using bulked segregant RNA-Seq

A gene encoding a laccase responsible for chartreuse onion bulb color was identified. Markers tagging this gene showed perfect linkage with bulb colors among diverse germplasm. To identify a casual gene for the G locus determining chartreuse bulb color in onion (Allium cepa L.), bulked segregant RNA-Seq (BSR-Seq) was performed using yellow and chartreuse individuals of a segregating population. Through single nucleotide polymorphism (SNP) and differentially expressed gene (DEG) screening processes, 163 and 143 transcripts were selected, respectively. One transcript encoding a laccase-like protein was commonly identified from SNP and DEG screening. This transcript contained four highly conserved copper-binding domains known to be signature sequences of laccases. This gene was designated AcLAC12 since it showed high homology with Arabidopsis AtLAC12. A 4-bp deletion creating a premature stop codon was identified in exon 5 of the chartreuse allele. Another mutant allele in which an intact LTR-retrotransposon was transposed in exon 5 was identified from other chartreuse breeding lines. Genotypes of molecular markers tagging AcLAC12 were perfectly matched with bulb color phenotypes in segregating populations and diverse breeding lines. All chartreuse breeding lines contained inactive alleles of DFR-A gene determining red bulb color, indicating that chartreuse color appeared when both DFR-A and AcLAC12 genes were inactivated. Linkage maps showed that AcLAC12 was positioned at the end of chromosome 7. Transcription levels of structural genes encoding enzymes in anthocyanin biosynthesis pathway were generally reduced in chartreuse bulk compared with yellow bulk. Concentrations of total quercetins were also reduced in chartreuse onion. However, significant amounts of quercetins were detected in chartreuse onion, implying that AcLAC12 might be involved in modification of quercetin derivatives in onion.

The proper timing of virtual reality experience for reducing preoperative anxiety of pediatric patients: A randomized clinical trial

BACKGROUND

The virtual reality (VR) experience of an operation room (OR) prior to anesthesia and surgery has been known to reduce the anxiety and distress of pediatric patients. However, the proper timing needed for this is unknown. This randomized clinical study aimed to evaluate the proper timing of a VR tour of an OR (a few days before vs. immediately before anesthesia) to reduce the anxiety in a pediatric patient undergoing elective surgery.

METHODS

The children from the ages of 4-10 years old were randomly divided into three groups. The control group received standard verbal information about the process of anesthesia and surgery 10 min before anesthesia. The VR A group experienced a VR tour at the outpatient clinic a few days before anesthesia, whereas the VR B group experienced the tour 10 min before anesthesia at the reception area of the OR. The 4-min VR video used in this study showed the experience of Pororo, an animation character, entering the OR and undergoing anesthesia. We evaluated the anxiety of children using the modified Yale preoperative anxiety scale (m-YPAS), the anxiety of caregivers using Beck anxiety inventory (BAI), and caregivers' satisfaction.

RESULTS

The m-YPAS of the VR B group was significantly lower than that of the control and VR A groups (p = 0.001), whereas there was no statistically significant difference in BAI (p = 0.605) among the 3 groups. The score of caregivers' satisfaction with the overall process of anesthesia and surgery was higher in VR A group than in the control and VR B groups (p = 0.054).

CONCLUSION

The VR experience of an OR immediately before anesthesia was more effective than standard verbal information or a VR tour at the outpatient clinic a few days before anesthesia in reducing the anxiety and distress of children prior to surgery.

CLINICAL TRIAL REGISTRATION

[https://cris.nih.go.kr/cris/search/detailSearch.do/20773], identifier [KCT0006845].

Genotyping-by-Sequencing Derived Genetic Linkage Map and Quantitative Trait Loci for Sugar Content in Onion (Allium cepa L.)

Onion (2n = 2x = 16) has been a nutritional, medicinal and economically valuable vegetable crop all over the world since ancient times. To accelerate the molecular breeding in onion, genetic linkage maps are prerequisite. However, construction of genetic linkage maps of onion remains relatively rudimentary due to a large genome (about 16.3 Gbp) as well as biennial life cycle, cross-pollinated nature, and high inbreeding depression. In this study, we constructed single nucleotide polymorphism (SNP)-based genetic linkage map of onion in an F₂ segregating population derived from a cross between the doubled haploid line '16P118' and inbred line 'Sweet Green' through genotyping by sequencing (GBS). A total of 207.3 Gbp of raw sequences were generated using an Illumina HiSeq X system, and 24,341 SNPs were identified with the criteria based on three minimum depths, lower than 30% missing rate, and more than 5% minor allele frequency. As a result, an onion genetic linkage map consisting of 216 GBS-based SNPs were constructed comprising eight linkage groups spanning a genetic length of 827.0 cM. Furthermore, we identified the quantitative trait loci (QTLs) for the sucrose, glucose, fructose, and total sugar content across the onion genome. We identified a total of four QTLs associated with sucrose (qSC4.1), glucose (qGC5.1), fructose (qFC5.1), and total sugar content (qTSC5.1) explaining the phenotypic variation (R²%) ranging from 6.07-11.47%. This map and QTL information will contribute to develop the molecular markers to breed the cultivars with high sugar content in onion.

Comparative Analysis of Lenvatinib and Hepatic Arterial Infusion Chemotherapy in Unresectable Hepatocellular Carcinoma: A Multi-Center, Propensity Score Study

The comparative efficacy and safety between lenvatinib and hepatic artery infusion chemotherapy (HAIC) in patients with unresectable hepatocellular carcinoma (HCC) is still unclear. This multicenter historical cohort study enrolled 244 patients who were treated with HAIC (n = 173) or lenvatinib (n = 71) between 2012 and 2020. Propensity score matching (PSM) was performed, and 52 patients were selected per group. Clinical outcomes and safety were compared. Objective response rate (ORR) was not different between the two groups (26.0% vs. 23.1%, p = 0.736). Before PSM, the HAIC group had a higher proportion of Child-Pugh B and portal vein tumor, whereas the lenvatinib group had more patients with extrahepatic metastases, which was adjusted after PSM. There were no differences in progression-free survival (PFS) and overall survival (OS) after PSM (HAIC vs. lenvatinib, median PFS, 3.6 vs. 4.0 months, p = 0.706; median OS 10.8 vs. 7.9 months, p = 0.106). Multivariate Cox-regression showed that alpha-fetoprotein ≤1000 ng/mL was only an associated factor for OS after PSM in all patients (hazard ratio = 0.421, p = 0.011). Subgroup analysis for patients with a high tumor burden beyond the REFLECT eligibility criteria revealed that the HAIC group (n = 29) had a significantly longer OS than did the lenvatinib group (n = 30) (10.0 vs. 5.4 months, p = 0.004). More patients in the HAIC group achieved better liver function than those in the lenvatinib group at the time of best responses. There was no difference in the incidence of grade 3 and 4 adverse events between the two groups. Therefore, lenvatinib is comparable to HAIC in terms of ORR and OS in unresectable HCC meeting REFLECT eligibility criteria.

[Cystic echinococcosis of the waist and hip: a case report]

A patient with cystic echinococcosis was presented with primary lesions in the waist and hip. The case was misdiagnosed as subcutaneous abscess at initial diagnosis, and then definitively diagnosed as echinococcosis by means of imaging examinations and anti-Echinococcus antibody test. This case was reported with aims to improve the awareness of cystic echinococcosis among clinical physicians to avoid and reduce the misdiagnosis and missing diagnosis.

Effects of extraction conditions on acrylamide/furan content, antioxidant activity, and sensory properties of cold brew coffee

The effects of extraction conditions on the acrylamide/furan content, antioxidant activity, and sensory properties of cold brew coffee were probed for samples prepared by steeping and dripping at various temperatures and for different times. Sensory properties were evaluated using a nine-point hedonic scale and an overall preference ranking test. Samples prepared by 3-h extraction featured the lowest acrylamide levels, while the lowest furan contents were observed for samples prepared by 24-h steeping and 12-h dripping. Among steeping-prepared samples, that extracted for 24 h showed the highest total phenol content, although no significant differences were observed for extraction times above 12 h, with a similar trend observed for ABTS free radical anion scavenging activity. Thus, the contents of bioactive and hazardous chemicals as well as sensory properties were found to be influenced by various extraction conditions.

Effects of Thawing and Frying Methods on the Formation of Acrylamide and Polycyclic Aromatic Hydrocarbons in Chicken Meat

Air frying is commonly used as a substitute for deep-fat frying. However, few studies have examined the effect of air frying on the formation of potential carcinogens in foodstuffs. This study aimed to investigate the formation of acrylamide and four types of polycyclic aromatic hydrocarbons (PAHs) in air-fried and deep-fat-fried chicken breasts, thighs, and wings thawed using different methods, i.e., by using a microwave or a refrigerator, or by water immersion. The acrylamide and PAHs were analyzed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and gas chromatography-mass spectrometry (GC-MS), respectively. Deep-fat-fried chicken meat had higher acrylamide (n.d.-6.19 μg/kg) and total PAH (2.64-3.17 μg/kg) air-fried chicken meat (n.d.-3.49 μg/kg and 1.96-2.71 μg/kg). However, the thawing method did not significantly affect the formation of either acrylamide or PAHs. No significant differences in the acrylamide contents were observed among the chicken meat parts, however, the highest PAH contents were found in chicken wings. Thus, the results demonstrated that air frying could reduce the formation of acrylamide and PAHs in chicken meat in comparison with deep-fat frying.

Risk factors of meconium-related ileus in very low birth weight infants: patients-control study

Very low birth weight (VLBW) neonates experience various problems, including meconium-related ileus (MRI). This study investigated the risk factors of MRI and surgical MRI in VLBW infants. VLBW neonates admitted to the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from October 2002 to September 2016 were included in the study. The diagnostic criteria for MRI were a decreased frequency of defecation with intolerable feeding, vomiting, and increased gastric residue (>50%); meconium-filled bowel dilatation in an imaging study; and no evidence of necrotizing enteritis or spontaneous intestinal perforation. Medical MRIs and surgical MRIs were managed through conventional treatment and surgical intervention. Of 1543 neonates, 69 and 1474 were in the patient and control groups, respectively. The risk factors for MRI include low birth weight (BW), cesarean section delivery, fetal distress, maternal diabetes, maternal hypertension, and maternal steroid use. Low BW and fetal distress were independent risk factors for MRI. Compared to the medical MRI group (n = 44), the risk factors for surgical MRI (n = 25) included males, younger gestational age, low BW, and meconium located at the small bowel. Male gender and low BW were independent risk factors for surgical MRI. Low BW and fetal distress were independent risk factors for MRI and male gender and low BW were independent risk factors for surgical MRI. In VLBW neonates, careful attention to the risk factors for MRI could minimize or avoid surgical interventions.

Clinical features of children with Haddad syndrome: A single-center experience

BACKGROUND/PURPOSE

Haddad syndrome (HS) is a very rare disease considered a form of neurocristopathy. It is characterized by a combination of congenital central hypoventilation syndrome (CCHS) and Hirschsprung's disease (HD). We report the clinical features and disease progression of HS to provide better care for HS patients by achieving an earlier diagnosis and optimal treatment.

METHODS

Medical records of patients diagnosed with HS from 2005 to 2016 were retrospectively reviewed. Demographic data including gestational age, birth weight and height, and paired-like homeobox 2b (PHOX2B) gene mutation were collected.

RESULTS

Seven males and three females were identified (mean gestational age 39.76 ± 1.49 weeks, mean birth weight 3117.5 ± 288.9 g). PHOX2B gene mutation was identified in all patients. Immediate ventilation care after birth was required in five patients due to poor respiration. The current median age of the children is 5.4 years (range, 1.8-10.1). Tracheostomy was performed in nine patients. Eight patients required sleep ventilation and two patients, 24-h continuous ventilation support. Six patients showed rectosigmoid aganglionosis and four patients exhibited total colonic aganglionosis, of these one had aganglionosis extended to the distal small bowel. Soiling was observed in seven patients (5 with laparoscopy-assisted transanal endorectal pull-through and 2 with Duhamel procedure) and one patient showed grade 2 constipation with Duhamel procedure. Six patients had developmental delay. All patients are alive.

CONCLUSIONS

HS may require lifelong medical care. This study could be helpful to understand the clinical features of HS including associated abnormalities and disease progression. By assisting to understand the clinical features, we could provide better care for HS patients by achieving an earlier diagnosis and appropriate treatment.

TYPE OF STUDY

Prognosis study.

LEVEL OF EVIDENCE

Level IV.

Botulinum toxin injection for internal anal sphincter achalasia after pull-through surgery in Hirschsprung disease

Botulinum toxin (Botox) was introduced for the management of internal anal sphincter (IAS) achalasia after a pull-through procedure in Hirschsprung disease (HD). We conducted a prospective evaluation of the efficacy and safety of this Botox treatment.Our study group included 15 patients with HD (median age, 4.8 years; range, 1.7-7.4 years) who experienced persistent constipation after pull-through surgery. Rectal biopsy and colon study were performed before Botox injection to exclude agangliosis. Intersphincteric Botox injections (dose, 4 IU/kg) were performed at 3 sites, (3, 6, and 9 o'clock) under general anesthesia. Measured outcomes of efficacy included anorectal manometry, Wexner constipation score and the quality of life score for defecation, measured at baseline and at 2 weeks and 3 months after injection. The Holschneider incontinence score and an assessment of pain, bleeding, heating sensation, and swelling were also performed at follow-up as outcomes of safety.There was no significant change in measured outcomes with Botox treatment. Botox did decrease the number of patients who experienced abdominal distension at 3 months, compared to 2-weeks, post-injection. No major complications were identified, with only 2 cases of anal bleeding that resolved spontaneously. Local tenderness at the injection site was reported by 4 patients, recovering without treatment.The efficacy of Botox, injected into the IAS, for the treatment of achalasia is questionable on short-term follow-up. Larger studies with a longer follow-up period and the use of repeated injections are required to evaluate the evidence for this treatment.

Why Do the Patients with Hirschsprung Disease Get Redo Pull-Through Operation?

INTRODUCTION

 The treatment of Hirschsprung disease (HD) is pull-through (PT) surgery. Redo PT can be performed in 1 to 10% of patients after initial PT. In this study, we reviewed the causes and associated factors of redo PT.

MATERIALS AND METHODS

 We retrospectively reviewed medical charts of 657 patients with HD who underwent surgeries between September 1979 and January 2016. The indications for redo PT are as follows. First, there were persistent obstructive symptoms after the first operation, (1) with transition zone shown definitely on contrast study, (2) with anatomic problems, and (3) obstructive symptoms persist despite conservative or nonredo surgical treatment without (1) and (2). We analyzed the causes and associated factors of redo PT.

RESULTS

 A total of 49 (7.5%) patients underwent redo PT. Among them, 41 and 8 patients underwent PT twice and three times, respectively. Among 57 cases of redo, the causes of redo included pathologic problem (n = 28)-aganglionosis (n = 20), hypoganglionosis (n = 4), immature ganglion cell (n = 4)-or anatomic problem (n = 21)-stricture (n = 13), fistula and/or abscess (n = 8) at anastomosis. Comparing associated factors between the nonredo and redo groups, the redo group had longer initial PT operation time (p = 0.001), more postoperative complications (p < 0.001), and more transanal endorectal PT (TERPT) approach as initial PTs (p < 0.001). According to causes of redo, the anatomic problem group underwent more third PTs than the pathologic problem group (p = 0.010).

CONCLUSION

 Approximately 7.5% of patients experienced redo PT. The cause of redo included pathologic (n = 28) or anatomic problem (n = 21). Longer operation time, more complications, and TERPT were associated with redo. The anatomic problem group underwent more third PTs than the pathologic problem group.

APOE Promoter Polymorphism-219T/G is an Effect Modifier of the Influence of APOE ε4 on Alzheimer's Disease Risk in a Multiracial Sample

Variants in the APOE gene region may explain ethnic differences in the association of Alzheimer’s disease (AD) with ε4. Ethnic differences in allele frequencies for three APOE region SNPs (single nucleotide polymorphisms) were identified and tested for association in 19,398 East Asians (EastA), including Koreans and Japanese, 15,836 European ancestry (EuroA) individuals, and 4985 African Americans, and with brain imaging measures of cortical atrophy in sub-samples of Koreans and EuroAs. Among ε4/ε4 individuals, AD risk increased substantially in a dose-dependent manner with the number of APOE promoter SNP rs405509 T alleles in EastAs (TT: OR (odds ratio) = 27.02, p = 8.80 × 10⁻⁹⁴; GT: OR = 15.87, p = 2.62 × 10⁻⁹) and EuroAs (TT: OR = 18.13, p = 2.69 × 10⁻¹⁰⁸; GT: OR = 12.63, p = 3.44 × 10⁻⁶⁴), and rs405509-T homozygotes had a younger onset and more severe cortical atrophy than those with G-allele. Functional experiments using APOE promoter fragments demonstrated that TT lowered APOE expression in human brain and serum. The modifying effect of rs405509 genotype explained much of the ethnic variability in the AD/ε4 association, and increasing APOE expression might lower AD risk among ε4 homozygotes.

Correction: The Rho/ROCK pathway for lysophosphatidic acid-induced proteolytic enzyme expression and ovarian cancer cell invasion

The original version of this article contained an error in the published figures Fig 2 and Fig 3f, where the information was inadvertently duplicated. This error does not alter the conclusions of the paper. The corrected figures are published in this correction notice. The authors sincerely apologize for this error.

[Transmission cluster and network of HIV-1 CRF01_AE strain in China, 1996-2014]

Objective: To understand the transmission patterns and risk factors of HIV-1 strain CRF01_AE subtypes in China, and to provide guidance for the implementation of precise intervention. Methods: A total of 2 094 CRF01_AE pol sequences were collected in 19 provinces in China between 1996 and 2014. Phylogenetic tree was constructed by PhyML 3.0 software to select the transmission clusters. Transmission network was constructed by Cytoscape 3.6.0, which was further used for exploring of the major risk factors. Results: Of the 2 094 sequences, 12.18% (255/2 094) were in clusters. A total of 82 transmission clusters were identified. The numbers of clusters and contained sequences in intra-provincial transmission (61, 173) were significantly more than those in inter-provincial transmission (21, 82). The ratio of transmission clustering in MSM increased over time from 2.41% (2/83) during 1996-2008 to 23.61% (72/305) during 2013-2014, showing a significant upward trend (χ(2)=27.800, df=1, P=0.000). The proportion of MSM with inter-provincial transmission clusters were higher than those with intra-provincial transmission clusters, which increased from 0.67% (2/297) during 1996-2008 to 6.36%(30/472) during 2013-2014, showing a significant upward trend (χ(2)=20.276, df=1, P=0.000). The transmission rate in homosexuals of the inter-transmission clusters (86.59%, 71/82) was higher than that of intra-provincial transmission clusters (56.65%, 98/173), and the difference was statistically significant (χ(2)=22.792, P=0.000). The proportion of inter-provincial transmission clusters with more than 2 transmission routes (33.33%, 7/21) was higher than that of intra-provincial clusters (13.11%, 8/61), and the difference was statistically significant (χ(2)=4.273, P=0.039). Results from the transmission network analysis indicated that the proportion of high risk population (degree≥4) with inter-provincial transmission clusters (51.22%, 42/82) was significantly higher than that with intra-provincial transmission clusters (26.59%, 46/173), and the difference was statistically significant (χ(2)=14.932, P=0.000). Inter-provincial clusters were mainly detected in and and MSM. Conclusions: Complex transmission networks were found for HIV-1 CRF01_AE strains in the mainland of China. Inter-provincial transmission clusters increased rapidly, MSM played an important role in the wide spread of the strain. More researches in transmission networks are needed to guide the precision intervention.

Abstract P5-07-10: The prognostic significance of estrogen formation as a consequence of aromatase expression in tumor microenvironment

Estrogen synthesis via aromatase in adipose tissue has an important role in progression of postmenopausal breast cancer. The increased local concentrations of estrogen in breast cancer via aromatase overexpression within the tumor tissue have been demonstrated by some investigators. Although aromatase inhibitor is the standard endocrine therapy for postmenopausal breast cancer patients, it is not uncommon for patients to have poor compliance to the drugs due to their side effects. This research is based on the hypothesis that if aromatase expression is related to prognosis and if therapeutic effect varies depending on the degree of aromatase expression, then this study may be able to suggest a new guideline in terms of choosing between aromatase inhibitors and tamoxifen.

Methods: 154 postmenopausal breast cancer patients who underwent surgery and aromatase inhibitor therapy in Busan Paik Hospital, Inje University from January 2005 to December 2010 were enrolled. Patients with DCIS or stage IV breast cancer were excluded. Patients' clinicopathological data were collected and TMA blocks were created for immunohistochemistry studies to examine aromatase expression.

Results: The recurrence has occured in 7 patients (6.9%). Stage, tumor size and number of lymph node metastasis were related to increased risk of recurrence (p=0.051, 0.043, 0.001). The aromatase expression in cancer cells had significant correlation with clinical stage (p=0.041). There was also a positive correlation between Ki67 and aromatase expression in cancer tissue (p=0.006). However, aromatase expression in cancer, stromal, and adipose tissue had no relationship with recurrence (p=0.410, 0.627, 0.552).

Correlation between clinicopathologic factors and aromatase expression (Linear by linear association and Spearman's correlation coefficient test)Site of aromatase expressionERPRKi67P53BMIStageIn Cancer0.6060.5920.0060.4510.9560.041In Stroma0.2200.4710.5840.3290.3670.229In Adipose0.9880.2650.1590.1170.7701.000

Conclusions: Aromatase expression in cancer cells was correlated with clinical stage. This implies that aromatase expression might have a role of prognostic marker in addition to role of treatment indicator. There was no direct correlation between aromatase expression and recurrence.

Citation Format: Kim TH, Lee A, Han JW, Jung SJ, Byun K-D. The prognostic significance of estrogen formation as a consequence of aromatase expression in tumor microenvironment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-07-10.

Prospective evaluation of clinical outcomes and quality of life after gastric tube interposition as esophageal reconstruction in children

Few studies on gastric tube interposition for esophageal reconstruction in children have assessed the long-term outcomes and quality of life (QoL). The aim of this study is to evaluate the long-term outcomes and QoL after a gastric tube interposition by reviewing our experiences with esophageal reconstruction.Twenty-six patients were included who underwent gastric tube interposition from 1996 to 2011 at our institution. We reviewed the medical records and conducted telephone surveys, prospectively performed esophagography, endoscopy, 24-hour pH monitoring, and esophageal manometry. The median follow-up period of 12 (range, 3-18) years.Median age at the time of surgery and survey were 9 (range, 2-50) months and 12.4 (range, 3.1-19.0) years, respectively. There were 14 cases of reoperation of gross type C and B esophageal atresia (EA) and 10 cases of long gap pure EA. The z scores of anthropometric data at the survey did not increase after the operation. Severe stricture in esophagography was observed in 20% of patients, but improved with balloon dilation with intact passage. Gastroesophageal reflux was able to be treated with medications. Esophageal peristalsis was observed in 1 of 8 patients in manometry. No Barrett esophagus or metaplasia was not found from endoscopy. QoL was similar to the general population and did not differ between age groups.Gastric tube interposition could be considered for esophageal reconstruction in pediatric patients when native esophageal anastomosis is impossible. Nutritional evaluation and support with consecutive radiological evaluation to assess the anastomosis site stricture are advised.

The Optimal Timing of Enterostomy Closure in Extremely Low Birth Weight Patients for Acute Abdomen

There are few reports on enterostomy closure (EC) timing for acute abdomen in extremely low birth weight (ELBW) patients. We retrospectively reviewed ELBW patients who underwent enterostomy formation (EF) and subsequent EC. We investigated baseline characteristics, surgical outcomes, and follow-up data of 55 patients and analyzed optimal timing by age at EC, enterostomy duration, and body weight (Bwt) at EC. The minimum p-value approach (MPA) using the Chi-squared test was used to determine each cut-off value. Mean gestational age was 25⁺³ weeks, while mean age and Bwt at EF were 10 days and 660 g. Enterostomy duration and Bwt at EC were 102 days and 2400 g. Fourteen surgical complications were related to EC. The MPA identified a cut-off of 2100 g (p = 0.039) at EC but no significant cut-off age or enterostomy duration. The 18 patients <2100 g had more enterostomy-related problems at EC than the >2100 g group (66.7% vs 10.8%, p < 0.001). No other characteristics were significantly different. Operation time, ventilator period, hospital stay, parenteral nutrition duration, and full feeding day were significantly longer in <2100 g patients. Follow-up Bwt did not differ (11.55 kg vs 13.95 kg, p = 0.324). Our findings suggest EC can be safely performed when Bwt is over 2100 g.

Predicting Survival of Congenital Diaphragmatic Hernia on the First Day of Life

BACKGROUND

This study aimed to determine perinatal risk factors for 30-day mortality of congenital diaphragmatic hernia (CDH) patients and develop a prognostic index to predict 30-day mortality of CDH patients. Identifying risk factors that can prognosticate outcome is critical to obtain the best management practices for patients.

METHODS

A retrospective study was performed for patients who were diagnosed with CDH from November 2000 to August 2016. A total of 10 prenatal risk factors and 14 postnatal risk factors were analyzed. All postnatal variables were measured within 24 h after birth.

RESULTS

A total of 95 CDH patients were enrolled in this study, including 61 males and 34 females with mean gestational age of 38.86 ± 1.51 weeks. The overall 30-day survival rate was 63.2%. Multivariate analysis revealed that five factors (polyhydramnios, gestational age at diagnosis <25 weeks, observed-to-expected lung-to-head ratio ≤45, best oxygenation index in 24 h  >11, and severity of tricuspid regurgitation ≥ mild) were independent predictors of 30-day mortality of CDH. Using these five factors, a perinatal prognostic index for 30-day mortality was developed. Four predictive models (poor, bad, good, and excellent) of the perinatal prognostic index were constructed, and external validation was performed.

CONCLUSIONS

Awareness of risk factors is very important for predicting prognosis and managing patients. Five independent perinatal risk factors were identified in this study. A perinatal prognostic index was developed for 30-day mortality for patients with CDH. This index may be used to help manage CDH patients.

Effects of scrambler therapy on pain and depression of patients with chronic low back pain: case study

[Purpose] This study was designed to investigate the effect of scrambler therapy on the pain and depression of patients with chronic low back pain. [Subject and Methods] Applied scrambler therapy to a 52 year-old man who was diagnosed with chronic low back pain, for 40 minutes once a day during the 10-day execution. Pain and depression were measured using the visual analogue scale and the Beck Depression Inventory. [Results] According to the measurement results, pain and depression decreased after ten sessions of scramble therapy. [Conclusion] Scrambler therapy shows positive effects on pain and depression of patients with chronic low back pain.

Effects of active vibration exercise using a Flexi-Bar on balance and gait in patients with chronic stroke

[Purpose] This study aimed to investigate the effect of active vibration exercise using a Flexi-Bar on the balance and gait of chronic stroke patients. [Subjects and Methods] Twenty-two patients with chronic stroke were randomly assigned to an experimental or control group (n=11 each). The experimental group performed active vibration exercise using a Flexi-Bar. Balance was measured using the Berg Balance Scale and Functional Reach Test. Gait was measured with the 10-meter Walk Test and Timed Up and Go Test. [Results] Intragroup comparisons in the experimental group showed significant differences in Berg Balance Scale, Functional Reach Test, 10-meter Walk Test, and Timed Up and Go Test results, whereas intergroup comparisons showed significant differences in Berg Balance Scale, Functional test, 10-meter Walk Test, and TUGT results. [Conclusion] On the basis of these results, it was concluded that active vibration exercise using a Flexi-Bar effectively improves the balance and gait of patients with chronic stroke.

[The timing of renal replacement therapy on mortality in patients with acute renal injury: a reanalysis of two recently published randomized control trials]

To investigate the sources of inconsistent findings between two randomized control trials["initiation strategies for renal-replacement therapy in the intensive care unit"(AKIKI trial) vs"effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury"(ELAIN trial) ], regarding"timing of renal replacement therapy (RRT) on mortality in patients with acute kidney injury (AKI). By reanalysis of the published data, it was found that demographics, severity of primary disease and stage of AKI before initiation of RRT were quite different between AKIKI and ELAIN trials. Interestingly, similar mortalities were demonstrated in late group of ELAIN trial, both of early and late groups of AKIKI trial [all patients were classified at Kidney Disease: Improving Global Outcomes (KDIGO) classification stage 3 of AKI, P>0.05] although a significant reduction of mortality was determined in early group of ELAIN trial (KDIGO stage 2 of AKI).Therefore, it was concluded that inconsistent results were largely attributable to the heterogeneity of enrolled patients between ELAIN vs AKIKI trials, including demographics and severity of AKI(AKI stage) before initiation of RRT.

The immediate effects of taping therapy on knee pain and depression in patients with degenerative arthritis

[Purpose] This study aims to identify the immediate effects of taping therapy on knee pain and depression among patients with degenerative arthritis. [Subjects and Methods] In total, 32 patients with degenerative arthritis were randomly assigned to one of two groups: the experimental group that underwent taping therapy and the control group that underwent regular treatment (16 patients per group). In the experimental group, therapeutic tape was wrapped all around the knee joint. Pain and depression were measured using the visual analogue scale (VAS) and the Beck Depression Inventory (BDI), respectively. [Results] The intra-group comparison showed significant differences in VAS and BDI for the experimental group. The intergroup comparison showed that the differences in VAS and BDI within the experimental group appeared significant relative to the control group. [Conclusion] It was observed that taping therapy showed an immediate effect in decreasing knee pain and depression among patients with degenerative arthritis.

The immediate effects of taping therapy on knee pain and depression in patients with degenerative arthritis

[Purpose] This study aims to identify the immediate effects of taping therapy on knee pain and depression among patients with degenerative arthritis. [Subjects and Methods] In total, 32 patients with degenerative arthritis were randomly assigned to one of two groups: the experimental group that underwent taping therapy and the control group that underwent regular treatment (16 patients per group). In the experimental group, therapeutic tape was wrapped all around the knee joint. Pain and depression were measured using the visual analogue scale (VAS) and the Beck Depression Inventory (BDI), respectively. [Results] The intra-group comparison showed significant differences in VAS and BDI for the experimental group. The intergroup comparison showed that the differences in VAS and BDI within the experimental group appeared significant relative to the control group. [Conclusion] It was observed that taping therapy showed an immediate effect in decreasing knee pain and depression among patients with degenerative arthritis.

Comparison of intraoperative basal fluid requirements in distal pancreatectomy: Laparotomy vs. laparoscopy: A retrospective cohort study

There has been recent progress in intraoperative fluid therapy. However, little is known about intraoperative fluid therapy in laparoscopic surgery. The purpose of this study is to determine whether there are differences in the basal fluid requirements during surgery between laparotomy and laparoscopic distal pancreatectomy.This retrospective cohort study analyzed the electronic medical records of 253 patients who underwent distal pancreatectomy via either laparotomy (73 patients) or laparoscopy (180 patients) between June 2006 and March 2016. The volume of intraoperative fluid administered, postoperative complications, length of hospital stay, and readmission rate were evaluated. The total volume of fluids was calculated as the sum of the volume of crystalloid plus the volume of colloid multiplied by 1.5 or 2.0.Patients who had laparotomy were older and had higher American Society of Anesthesiologists classes. Anesthesia time was longer and estimated blood loss was larger in laparotomy. More colloid (1.8 mL/kg per h vs. 1.2 mL/kg per h, P < .001) and more total calculated fluid (1.5 times: 11.7 mL/kg per h vs. 10.6 mL/kg per h, P = .002; 2.0 times: 12.6 mL/kg per h vs. 11.2 mL/kg per h, P = .001) were infused in laparotomy. Crystalloid (9.0 mL/kg per h vs. 8.9 mL/kg per h, P = .203) did not show significant difference. Postoperative complications were more frequent (63% vs. 45%, P = .008), the hospital stay was longer (18 days vs. 13.4 days, P < .001), and readmission rate was higher (15% vs. 5.6%, P = .02) in laparotomy. By logistic regression analysis, we could find that operation type (laparotomy vs. laparoscopy, odds ratio 1.900, 95% confidence interval 1.072-3.368) and operation time (P = .004) had effect on complications.In patients undergoing distal pancreatectomy, basal fluid requirements were larger in laparotomy compared with laparoscopy. Operation time and estimated blood loss had effects on fluid administration. Postoperative complications were more frequent in laparotomy but we could not find relationships with infused colloid or total calculated fluid volumes. Operation type (laparotomy vs. laparoscopy) and operation time were the only related factors to postoperative complications.

Intestinal obstruction due to kaposiform hemangioendothelioma in a 1-month-old infant: A case report

RATIONALE

Kaposiform hemangioendothelioma (KHE) is an aggressive vascular tumor, mainly occurring in infants and young children and previously reported cases were mainly cutaneous or visceral form. Intestinal kaposiform hemangioma was first reported in 2012. Intestinal type KHE showed better prognosis if the lesion was limited in the gastrointestinal tract and coagulopathy was not accompanied. Since the number of reported cases is small, further study for treatment options and prognosis need to be done.

PATIENT CONCERNS

We described the case of a 1-month-old female who had abdominal distention and bilious vomiting.

DIAGNOSES

She was suspected as intestinal obstruction after diagnostic work up.

INTERVENTIONS

Surgical exploration was performed and jejunal obstruction with a mass was identified. Small bowel segmental resection and anastomosis was performed.

OUTCOMES

The patient discharged with symptom free. Through the pathological examination, the mass was identified as intestinal type KHE.

LESSONS

Intestinal KHE can cause bowel obstruction and be managed successfully with complete surgical resection. More cases should be reported and further evaluation for treatment options and prognosis evaluation is necessary.

Specific PCR detection of Fusarium oxysporum f. sp. raphani: a causal agent of Fusarium wilt on radish plants

Fusarium oxysporum, a causal agent of Fusarium wilt, is one of the most important fungal pathogens worldwide, and detection of F. oxysporum DNA at the forma specialis level is crucial for disease diagnosis and control. In this study, two novel F. oxysporum f. sp. raphani (For)-specific primer sets were designed, FOR1-F/FOR1-R and FOR2-F/FOR2-R, to target FOQG_17868 and FOQG_17869 ORFs, respectively, which were selected based on the genome comparison of other formae speciales of F. oxysporum including conglutinans, cubense, lycopersici, melonis, and pisi. The primer sets FOR1-F/FOR1-R and FOR2-F/FOR2-R that amplified a 610- and 425-bp DNA fragment, respectively, were specific to For isolates which was confirmed using a total of 40 F. oxysporum isolates. From infected plants, the FOR2-F/FOR2-R primer set directly detected the DNA fragment of For isolates even when the radish plants were collected in their early stage of disease development. Although the loci targeted by the For-specific primer sets were not likely involved in the pathogenesis, the primer set FOR2-F/FOR2-R is available for the determination of pathogenicity of radish-infecting F. oxysporum isolates. This study is the first report providing novel primer sets to detect F. oxysporum f. sp. raphani.

SIGNIFICANCE AND IMPACT OF THE STUDY

Because plant pathogenic Fusarium oxysporum has been classified into special forms based on its host specificity, identification of F. oxysporum usually requires a pathogenicity assay as well as knowledge of the morphological characteristics. For rapid and reliable diagnosis, this study provides PCR primer sets that specifically detect Fusarium oxysporum f. sp. raphani (For) which is a devastating pathogen of radish plants. Because one of the primer sets directly detected the DNA fragment of For isolates from infected plants, the specific PCR method demonstrated in this study will provide a foundation for integrated disease management practices in commodity crops.

Previsional space during direct laryngoscopy: Implication in the difficult laryngoscopy

The laryngoscope should displace oral soft tissues forward out of the operator's vision. Therefore, the space in front of the view may be critical for determining the laryngoscopic view. The aim was to investigate the difference in the previsional space during difficult versus easy laryngoscopy (EL).Under general anesthesia, digital photographs of the lateral view of the head and neck were taken in the horizontal sniffing position, after head extension, and during laryngoscopy with a defined force (50 N). Three points (thyroid notch (T), maxillary incisor (I), and mandibular mentum (M)) were marked on the photograph. The previsional space was defined as the TIM triangle. We compared these areas and other variables of the TIM triangle between male patients with difficult laryngoscopy (DL: Cormack-Lehane III-IV, n = 12) versus those of age- and body mass index-matched male patients with EL (Cormack-Lehane I-II, n = 12).When the head was extended, the areas TIM triangle in DL were significantly smaller than in EL. During laryngoscopy, all values of the TIM triangle in DL, including the TIM area (16.4 ± 3.7 vs 22.6 ± 2.8 cm, P < .01), were significantly smaller than the values in EL.The previsional space was smaller in patients with DL than in those with EL. The TIM triangle could suggest new way to explain the mechanism underlying DL.

Analysis of clinical features of lipoblastoma in children

OBJECTIVE

A lipoblastoma is pathologically benign but often recurs. Due to its rarity, studies are scarce. The purpose of this study was to investigate the clinical characteristics of lipoblastoma occurring in children and to detect any correlations with the expression of Ki-67.

PARTICIPANTS

From 1998 to 2010, 33 patients were diagnosed with lipoblastoma at Seoul National University Children's Hospital.

METHODS

Ki-67 immunohistochemistry staining of the tumor tissue was performed.

RESULTS

A total of 33 patients (64% males) were enrolled in the study, with a mean age of 28 month. Eleven and 22 lesions were deep and superficial, respectively. Complete excisions were performed for 30 patients, and three underwent incomplete excisions. Two patients who underwent incomplete excision subsequently underwent a second operation due to tumor regrowth, and one patient had a recurrence despite complete excision. There was no statistically significant correlation observed between the tumor size or recurrence and the expression of Ki-67.

CONCLUSIONS

Lipoblastoma requires an accurate diagnosis and operative resection to alleviate the symptoms induced by its growth. Incompletely resected tumor may regrow; therefore, complete excision is the treatment of choice. Continuous follow-up is needed to monitor for recurrence of disease, even after a complete excision.

Application of emitter-sample hybrid terahertz time-domain spectroscopy to investigate temperature-dependent optical constants of doped InAs

We investigate temperature-dependent carrier dynamics of InAs crystal by using reflection-type terahertz time-domain spectroscopy, particularly with a recently developed emitter-sample hybrid structure. We successfully obtain the optical conductivity in a terahertz frequency of bulk InAs whose dc conductivity is in the range of 100-150  Ω^-1 cm^-1. We find that both real and imaginary parts of the optical conductivity can be fit well with the simple Drude model, and the free-carrier density and the scattering rate obtained from the fit are in good agreement with corresponding values obtained by using other techniques, such as the Hall measurement and the dc-resistivity measurement. These results clearly demonstrate that the proposed technique of adopting the emitter-sample hybrid structure can be exploited to determine temperature-dependent optical constants in a reflection geometry and hence to investigate electrodynamics of bulk metallic systems.

A case report of congenital umbilical arteriovenous malformation complicated with liver failure after surgical excision

RATIONALE

Few case reports of umbilical arteriovenous malformation (AVM) have been reported. Herein, we report a neonatal case of umbilical AVM who underwent liver failure after surgical excision.

PATIENT CONCERNS

The patient was a girl delivered at a gestational age of 39+5 weeks showing cyanosis and heart murmur.

DIAGNOSES

Cardiac echography, abdominal ultrasonography (USG), and computed tomography revealed suspecting the umbilical AVM.

INTERVENTIONS

On the eighth day after birth, because of the aggravation of heart failure, emergency surgery for excision of umbilical AVM was performed.

OUTCOMES

In postoperative state, worsened laboratory test of liver function and coagulopathy indicated the liver failure. Abdominal USG revealed that the portal vein (PV) flow primarily occurred from the left PV to the inferior vena cava via ductus venosus and coarse hepatic echogenicity. After conservative management, laboratory findings of liver function and the flow direction of the left PV were normal, as demonstrated by abdominal USG within 50th postoperative day.

LESSONS

Careful preoperative evaluation of an AVM of a large size with significant blood flow should be performed, and the possibility of liver failure after surgery should always be considered.

Right iliac arterial aneurysm in a 4-year-old girl who does not have a right external iliac artery

Pediatric arterial aneurysm is rare disease. Among them, idiopathic-congenital arterial aneurysm is extremely rare. This is a case report of right common iliac artery idiopathic aneurysm with absence of right external iliac artery. A 4-year-old girl who had been complaining of intermittent abdominal pain since 2 years prior presented with a right lower abdominal mass that had been palpable since 6 months prior. Abdominal CT revealed a 5.2 cm × 4.5 cm × 5.1 cm, right-sided, partially thrombosed, saccular, iliac artery aneurysm. She underwent to operation, aneurismal resection. A pathological examination confirmed that it was a true aneurysm, considering that all layers of the vascular wall were stretched with no deficit. The patient was discharged 3 days after the surgery without any complication. Five months passed since the surgery, and the patient is doing well without any abdominal or leg pain.

Abdominal tumors in children: Comparison between minimally invasive surgery and traditional open surgery

The use of minimally invasive surgery (MIS) in pediatric patients has been steadily increasing in recent years. However, its use for diagnosing and treating abdominal tumors in children is still limited compared with adults, especially when malignancy is a matter of debate. Here, we describe the experience at our center with pediatric abdominal tumors to show the safety and feasibility of MIS.Based on a retrospective review of patient records, we selected for study those pediatric patients who had undergone diagnostic exploration or curative resection for abdominal tumors at a single center from January 2010 through August 2015.Diagnostic exploration for abdominal tumors was performed in 32 cases and curative resection in 173 cases (205 operations). MIS was performed in 11 cases of diagnostic exploration (34.4%) and 38 cases of curative resection (21.9%). The mean age of the children who underwent MIS was 6.09 ± 5.2 years. With regard to diagnostic exploration, patient characteristics and surgical outcomes were found to be similar for MIS and open surgery. With regard to curative resection, however, the mean age was significantly lower among the patients who underwent open surgery (4.21 ± 4.20 vs 6.02 ± 4.99 for MIS, P = 0.047), and the proportion of malignancies was significantly higher (80% vs 39.4% for MIS, P < 0.001). MIS compared favorably with open surgery with respect to the rate of recurrence (6.7% vs 35.1%, P = 0.035), the rate of intraoperative transfusions (34.2% vs 58.5%, P = 0.01), the median amount of blood transfused (14 vs 22 mL/kg, P = 0.001), and the mean number of hospital days (4.66 ± 2.36 vs 7.21 ± 5.09, P < 0.001). Complication rates did not differ significantly between the MIS and open surgery groups. The operation was converted to open surgery in 3 cases (27.2%) of diagnostic MIS and in 5 cases (13.1%) of curative MIS.MIS was found to be both feasible and effective for the diagnosis and curative treatment of pediatric abdominal tumors. However, to determine the surgical role and guidelines for MIS for each specific tumor, a multicenter prospective study with a long-term follow-up is warranted.

Hepatocellular carcinoma after the Fontan procedure in a 16-year-old girl: A case report

INTRODUCTION

The Fontan procedure (FP) has become the standard operation for patients with single ventricle physiology. However, a long period of elevated systemic venous pressure and low cardiac output after the procedure result in chronic inflammation and liver cirrhosis, which may eventually lead to the occurrence of hepatocellular carcinoma (HCC).

CLINICAL FINDINGS

We described the case of a 16-year-old female who developed HCC after the FP. At 21 months, the patient received a lateral tunnel FP, and 14 years later, she began complaining of abdominal distension, telangiectasia, and fatigue. Imaging studies revealed a large hepatic mass involving most of the right lobe and multiple masses in the left lobe. Evidence suggested severe liver cirrhosis, and the presence of ascites, hepatosplenomegaly, paraesophageal gastric varices reflecting the severity of the disease. In addition, tumor thrombosis was found in the right hepatic vein, middle hepatic vein, and inferior vena cava, as well as multiple metastatic nodules in both lungs. The patient received an incisional biopsy and the diagnosis of HCC was pathologically confirmed. After treatment with 1 cycle of systemic chemotherapy, she received ongoing supportive care for disease-related complications, and died 2 months after chemotherapy due to hematemesis.

CONCLUSION

With the advances in medicine, the incidence of Fontan physiology-related complications is likely to increase, and the incidence of HCC will also increase accordingly. As early diagnosis of HCC results in better patient outcomes, a surveillance guideline for HCC after the FP should be developed.

Juniperus rigida Sieb. extract inhibits inflammatory responses via attenuation of TRIF-dependent signaling and inflammasome activation

ETHNOPHARMACOLOGICAL RELEVANCE

Juniperus rigida Sieb. (J. rigida) is used for medicinal purposes in Asian countries to treat inflammation-related disorders, such as neuralgia, dropsy, and gout.

AIM OF THE STUDY

The anti-inflammatory effects of J. rigida extract (JR) and its underlying mechanisms were explored both in in vitro cell lines and in vivo metabolic disease models.

MATERIAL AND METHODS

Lipopolysaccharide (LPS)-stimulated RAW264.7 murine macrophages were used to study the changes in inflammatory responses in vitro. Bone marrow-derived macrophages (BMDMs) were used to study the regulatory effect of JR on inflammasome activation. The murine model for monosodium urate (MSU)-induced peritonitis and high-fat diet (HFD)-induced type 2 diabetes were employed to study the effect of JR on in vivo efficacy.

RESULTS

JR suppressed the MSU-induced in vivo inflammatory response by attenuation of proinflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α). In the in vitro study, JR suppressed IL-1β secretion via regulation of apoptosis-associated speck-like protein containing a CARD (ASC) oligomerization, leading to the inhibition of inflammasome activation. JR also inhibited the LPS-stimulated release of proinflammatory mediators, such as nitric oxide (NO), TNF-α, and IL-6 in RAW264.7 cells. The inhibitory effects of JR were mediated through the regulation of the TRIF-dependent signaling pathway from JAK1/STAT1 phosphorylation. Furthermore, JR showed inhibitory effects on HFD-induced type 2 diabetes in a mouse model through the regulation of blood glucose and serum IL-1β.

CONCLUSIONS

Our results indicate that JR attenuates both LPS-stimulated and danger-signal-induced inflammatory responses in macrophages via regulation of the key inflammatory mechanisms, providing scientific support for its traditional use in the treatment of various inflammation-related metabolic disorders.

Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery: A Prospective, Double-Blind, and Randomized Trial

Breast cancer surgery is known to cause severe acute postoperative pain, which can persist for a long time. We administered nefopam preventively to patients undergoing lumpectomy with axillary lymph node dissection or sentinel lymph node biopsy, and evaluated its efficacy on acute and chronic postoperative pain.Enrolled patients were assigned to the nefopam (n = 41) or the control (n = 42) group. Before initiating the operation, 20 mg of nefopam was given to the patients of the nefopam group, and normal saline was used in the control group. Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups. Pain was assessed using a numerical rating scale (NRS), and the rescue analgesic drug was given when the NRS was >5. Implementation of postoperative chemotherapy, radiotherapy (RT), or hormone therapy was evaluated.The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the postanesthetic care unit (4.5 ± 2.2 vs 5.7 ± 1.5, respectively; P = 0.01), at postoperative 6 h (3.0 ± 1.6 vs 4.5 ± 1.3, respectively; P < 0.001), and at postoperative 24 h (3.1 ± 1.1 vs 3.8 ± 1.5, respectively; P = 0.01) with reduced use of rescue analgesic drugs. Significantly fewer patients suffered from chronic postoperative pain in the nefopam than in the control group at postoperative 3 months (36.6% vs 59.5%, P = 0.04). Considering only the cohort without postoperative adjuvant RT, the difference in the proportion of patients reporting chronic pain increased (23.5% in the nefopam group vs 61.5% in the control group, P = 0.04).Preventive nefopam was helpful in reducing the acute postoperative pain, with reduced use of rescue analgesic drugs, and it contributed to reduced occurrence of chronic pain at postoperative 3 months after breast cancer surgery.

Self-expandable metal stents for malignant esophageal obstruction: a comparative study between extrinsic and intrinsic compression

Self-expandable metal stents (SEMSs) are effective for malignant esophageal obstruction, but usefulness of SEMSs in extrinsic lesions is yet to be elucidated. This study is aimed at evaluating the clinical usefulness of SEMSs in the extrinsic compression compared with intrinsic. A retrospective review was conducted for 105 patients (intrinsic, 85; extrinsic, 20) with malignant esophageal obstruction who underwent endoscopic SEMSs placement. Technical and clinical success rates were evaluated and clinical outcomes were compared between extrinsic and intrinsic group. Extrinsic group was mostly pulmonary origin. Overall technical and clinical success rate was 100% and 91%, respectively, without immediate complications. Extrinsic and intrinsic group did not differ significantly in clinical success rate. The median stent patency time was 131.3 ± 85.8 days in intrinsic group while that of extrinsic was 54.6 ± 45.1 due to shorter survival after stent insertion. The 4-, 8-, and 12-week patency rates were 90.5%, 78.8%, and 64.9% respectively in intrinsic group, while stents of extrinsic group remained patent until death. Uncovered, fully covered, and double-layered stent were used evenly and the types did not influence patency in both groups. In conclusion, esophageal SEMSs can safely and effectively be used for malignant extrinsic compression as well as intrinsic.

Antifungal activity of rimocidin and a new rimocidin derivative BU16 produced by Streptomyces mauvecolor BU16 and their effects on pepper anthracnose

AIMS

The objective of this study was to explore antifungal metabolites targeting fungal cell envelope and to evaluate the control efficacy against anthracnose development in pepper plants.

METHODS AND RESULTS

A natural product library comprising 3000 microbial culture extracts was screened via an adenylate kinase (AK)-based cell lysis assay to detect antifungal metabolites targeting the cell envelope of plant-pathogenic fungi. The culture extract of Streptomyces mauvecolor strain BU16 displayed potent AK-releasing activity. Rimocidin and a new rimocidin derivative, BU16, were identified from the extract as active constituents. BU16 is a tetraene macrolide containing a six-membered hemiketal ring with an ethyl group side chain instead of the propyl group in rimocidin. Rimocidin and BU16 showed broad-spectrum antifungal activity against various plant-pathogenic fungi and demonstrated potent control efficacy against anthracnose development in pepper plants.

CONCLUSIONS

Antifungal metabolites produced by S. mauvecolor strain BU16 were identified to be rimocidin and BU16. The compounds displayed potent control efficacy against pepper anthracnose.

SIGNIFICANCE AND IMPACT OF THE STUDY

Rimocidin and BU16 would be active ingredients of disease control agents disrupting cell envelope of plant-pathogenic fungi. The structure and antifungal activity of rimocidin derivative BU16 is first described in this study.

Cichorium intybus Linn. Extract Prevents Type 2 Diabetes Through Inhibition of NLRP3 Inflammasome Activation

This study provides the scientific basis for the inhibitory effect of the aerial parts of Cichorium intybus Linn. (C. intybus) on the activation of the NLRP3 inflammasome in vitro and on high-fat diet (HFD)-induced type-2 diabetes (T2D). Lipopolysaccharide (LPS)-primed bone marrow-derived macrophages were used to study the effects methanolic extract of C. intybus leaf (CI) on inflammasome activation. An insulin resistance model (mice fed a HFD) was used to study the in vivo effect of CI on T2D. CI attenuated interleukin-1β (IL-1β) secretion by inhibiting the activation of the NLRP3 inflammasome in mouse bone marrow macrophages. The CI treatment attenuated the intracellular movement of NLRP3 in Triton X-100 insoluble fraction, without affecting the expression of other NLRP3 inflammasome-related proteins. Attenuated IL-1β secretion may improve glucose metabolism in the HFD-fed insulin resistance mouse model. CI also attenuated the infiltration of M1 macrophages and increased the M2 macrophage population in white adipose tissue. Collectively, our data showed that CI inhibits IL-1β secretion through attenuation of NLRP3 inflammasome activation, leading to an antidiabetic effect by improving glucose metabolism and inhibiting metainflammation.

Anti-inflammatory properties of Morus bombycis Koidzumi via inhibiting IFN-β signaling and NLRP3 inflammasome activation

ETHNOPHARMACOLOGICAL RELEVANCE

Morus bombycis Koidzumi (M. bombycis, Moraceae) has been used in Asian countries as a traditional medicine for the treatment of hypertension, diabetes, and inflammation-related disorders.

AIM OF STUDY

Although its anti-inflammatory actions have been partly documented, scientific evidence involving its molecular mechanisms related to inflammasome activation signaling pathways remains unknown.

MATERIALS AND METHODS

Lipopolysaccharide-stimulated RAW 264.7 cells and bone marrow-derived murine macrophages were used to study the in vitro effect of methanolic extract of M. bombycis (MB) on inflammatory responses. A monosodium urate crystal (MSU)-induced peritonitis murine model was used to study the in vivo effects.

RESULTS

MB attenuated the production of nitric oxide and interleukin-6, through the regulation of the interferon-β receptor signaling pathway. MB also inhibited IL-1β secretion via attenuation of NLRP3 inflammasome activation. Furthermore, MB inhibited MSU-induced peritonitis in the in vivo murine model.

CONCLUSIONS

This study provides the key molecular mechanisms involved in the anti-inflammatory effects of M. bombycis, substantiating the traditional claims of its use in the treatment of inflammation-related disorders.

Anti-inflammatory effect of Impatiens textori Miq. extract via inhibition of NLRP3 inflammasome activation in in vitro and in vivo experimental models

ETHNOPHARMACOLOGICAL RELEVANCE

Impatiens textori Miq. (I. textori, Balsaminaceae) is a traditional medicinal herb used for centuries to treat several inflammatory related skin infections and allergic disorders in Asian countries.

AIM OF THE STUDY

In this study, we elucidated the effects of whole plant extracts of I. textori on inflammasome activation using in vitro and in vivo models.

MATERIALS AND METHODS

LPS-stimulated murine bone marrow macrophages were used to study the regulatory effect of I. textori extract (IT) on inflammasome activation. ATP, nigericin and MSU were used as danger-associated molecules to activate the NLRP3 inflammasome. An LPS-induced acute lung injury (ALI) mouse model was used to study the in vivo effect of IT on inflammasome activation.

RESULTS

IT treated at 25, 50, and 100μg/mL concentrations suppressed interleukin-1β secretion through the attenuation of NLRP3 inflammasome activation (p<0.001 at 100μg/mL) leading to the decreased amount of ASC oligomerization and caspase-1 maturation. For the in vivo model, IT inhibited the NLRP3 expression and cell recruitment at the lung tissue in the ALI mouse model.

CONCLUSION

IT exhibited potent anti-inflammatory effects via the attenuation of NLRP3 inflammasome activation supporting the traditional claims and may provide a valuable therapeutic strategy in treating various inflammation-related disorders.