Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis

BACKGROUND

Total mesorectal excision using conventional straight fixed devices may be technically difficult because of the narrow and concave pelvis. Several laparoscopic articulating tools have been introduced as an alternative to robotic systems. The aim of this study was to compare perioperative outcomes between laparoscopic low anterior resection using ArtiSential® and robot-assisted surgery for rectal cancer.

METHODS

This retrospective study included 682 patients who underwent laparoscopic or robotic low anterior resection  for rectal cancer from September 2018 to December 2021. Among them, 82 underwent laparoscopic surgery using ArtiSential® (group A) and 201 underwent robotic surgery (group B). A total of 73 [group A; 66.37 ± 11.62; group B 65.79 ± 11.34] patients were selected for each group using a propensity score matching analysis.

RESULTS

There was no significant difference in the baseline characteristics between group A and B. Mean operative time was longer in group B than A (163.5 ± 61.9 vs 250.1 ± 77.6 min, p < 0.001). Mean length of hospital stay was not significantly different between the two groups (6.2 ± 4.7 vs 6.7 ± 6.1 days, p = 0.617). Postoperative complications, reoperation, and readmission within 30 days after surgery were similar between the two groups. Pathological findings revealed that the circumferential resection margins were above 10 mm in both groups (11.00 ± 7.47 vs 10.17 ± 6.25 mm, p = 0.960). At least 12 lymph nodes were sufficiently harvested, with no significant difference in the number harvested between the groups (20.5 ± 9.9 vs 19.7 ± 7.3, p = 0.753).

CONCLUSIONS

Laparoscopic low anterior resection using ArtiSential® can achieve acceptable clinical and oncologic outcomes. ArtiSential®, a multi-joint and articulating device, may serve a feasible alternative approach to robotic surgery in rectal cancer.

The potential cytotoxic effects of urban particle matter on olfaction

BACKGROUND

Urban particulate matter (UPM) in ambient air is implicated in a variety of human health issues worldwide, however, few studies exist on the effect of UPM on the olfactory system. This study aimed to identify the factors affecting the destruction of the olfactory system in a mouse model following UPM exposure.

METHODS

Mice were divided into: control and four UPM-exposed groups (200 µg UPM at 1 and 2 weeks, and 400 µg UPM at 1 and 2 weeks [standard reference material 1649b; average particle diameter 10.5 μm]). The olfactory neuroepithelium was harvested for histologic examination, gene ontology, quantitative real-time polymerase chain reaction, and western blotting.

RESULTS

Compared to the control group, olfactory marker protein, Olfr1507, ADCY3, and GNAL mRNA levels were lower, and S-100, CNPase, NGFRAP1, BDNF, and TACR3 mRNA levels were higher in the olfactory neuroepithelium of the UPM groups. Moderately positive correlation was present between the 1- and 2-week groups. After analyzing the 200 and 400 UPM groups separately, the strength of the association between the 200 UPM 1- and 2-week groups was moderately positive. No differences was present in the neuroepithelial inflammatory marker levels between the UPM and control groups.

CONCLUSIONS

UPM could have cytotoxic effects on the olfactory epithelium. The exposure time and particular concentration of UPM exposure could affect the degree of destruction of the olfactory neuroepithelium. The olfactory regeneration mechanism could be related to the neurotrophic factors, olfactory ensheathing cell stimulation, and trigeminal nerve support.

Computed tomography-negative symptomatic intracerebral hemorrhage in a patient with cerebral small vessel disease: A case report

RATIONALE

Computed tomography plays a key role in the initial evaluation of suspected acute stroke by ruling out the possibility of hemorrhage before thrombolysis. Recently, many reports have described cases of symptomatic microbleeds, and there may also have been a case of computed tomography- negative intracerebral hemorrhage.

PATIENT CONCERNS

A 70-year-old female patient who had a history of lacunar infarction and severe small vessel disease developed dysarthria. On brain non-contrast computed tomography there was no evidence of intracerebral hemorrhage. However, brain magnetic resonance imaging performed at 3 hours after the initial computed tomography showed cerebral hemorrhage.

DIAGNOSES

The diagnosis was computed tomography-negative intracerebral hemorrhage.

INTERVENTIONS

The patient was treated with cilostazole 100 mg twice a day with blood pressure management.

OUTCOMES

The dysarthria was fully recovered within 5 days and the patient did not suffer recurrent stroke symptoms over the following 2 years.

LESSONS

In patients with underlying severe small vessel disease and microbleeds, there could be computed tomography-negative hemorrhage and susceptibility weighted magnetic resonance image could be needed. More attention is required before applying thrombolysis therapy because there is a possibility of cerebral hemorrhage in those patients.

Use of methotrexate in the management of recurrent Tolosa-Hunt syndrome: Two case reports

RATIONALE

Tolosa-Hunt syndrome (THS) is rare condition characterized by painful ophthalmoplegia that usually responds well to corticosteroid. About a half of THS patients experience recurrence within intervals of months to years from initial presentation. Recurrence is more common in younger patients, and can be ipsilateral, contralateral, or bilateral. Cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, infliximab, and radiotherapy can be considered as second-line treatment. However, there is insufficient evidence for treatments preventing recurrence of THS.

PATIENT CONCERNS

We experienced two patients with THS that recurred twice while tapering or after ceasing corticosteroid administration.

DIAGNOSIS

Both patients were diagnosed as recurrent THS.

INTERVENTIONS

Methotrexate was treated with a combination of corticosteroid after THS recurred twice with corticosteroid therapy alone.

OUTCOMES

After adding methotrexate to the steroid regimen, their symptoms were successfully regulated and ceased to recur LESSONS:: These cases add to the evidence for the use of methotrexate as a second-line therapeutic agent for those patients with recurrent THS attacks. Further studies are in need to prove the risk and benefits of second-line treatments in THS.

Multi-omic analysis of the effects of low frequency ventilation during cardiopulmonary bypass surgery

BACKGROUND

Heart surgery with cardio-pulmonary bypass (CPB) is associated with lung ischemia leading to injury and inflammation. It has been suggested this is a result of the lungs being kept deflated throughout the duration of CPB. Low frequency ventilation (LFV) during CPB has been proposed to reduce lung dysfunction.

METHODS

We used a semi-biased multi-omic approach to analyse lung biopsies taken before and after CPB from 37 patients undergoing coronary artery bypass surgery randomised to both lungs left collapsed or using LFV for the duration of CPB. We also examined inflammatory and oxidative stress markers from blood samples from the same patients.

RESULTS

30 genes were induced when the lungs were left collapsed and 80 by LFV. Post-surgery 26 genes were significantly higher in the LFV vs. lungs left collapsed, including genes associated with inflammation (e.g. IL6 and IL8) and hypoxia/ischemia (e.g. HIF1A, IER3 and FOS). Relatively few changes in protein levels were detected, perhaps reflecting the early time point or the importance of post-translational modifications. However, pathway analysis of proteomic data indicated that LFV was associated with increased "cellular component morphogenesis" and a decrease in "blood circulation". Lipidomic analysis did not identify any lipids significantly altered by either intervention.

DISCUSSION

Taken together these data indicate the keeping both lungs collapsed during CPB significantly induces lung damage, oxidative stress and inflammation. LFV during CPB increases these deleterious effects, potentially through prolonged surgery time, further decreasing blood flow to the lungs and enhancing hypoxia/ischemia.

Comparison of open and pneumovesical approaches for Politano-Leadbetter ureteric reimplantation: a single-center long-term follow-up study

PURPOSE

To report our experience with the laparoscopic pneumovesical approach for Politano-Leadbetter ureteric reimplantation and to compare the results to those obtained using a traditional open approach.

METHODS

We retrospectively reviewed the medical records of 52 patients who underwent Politano-Leadbetter ureteral reimplantation between 2012 and 2017. The peri-operative parameters, postoperative outcomes, and complication rates of patients who underwent the open approach for the Politano-Leadbetter procedure and those who underwent the laparoscopic pneumovesical approach were compared.

RESULTS

During the study period, 52 ureteric reimplantation procedures were analyzed. Among these, 28 and 24 patients underwent surgery using the open and pneumovesical approaches, respectively. The mean operative time did not differ between the groups (143.64 min vs. 128.12 min, P = 0.092). However, the pneumovesical group had a shorter duration of hospital stay (5.08 days vs 7.43 days, P = 0.001) and required less morphine analgesic for pain than did the open group (7.7% vs 32.1%, P = 0.027). No significant differences in the success rates (94.9% vs 92.5%, P = 0.512) or procedure-related complications were noted between the pneumovesical and open techniques.

CONCLUSIONS

The transvesicoscopic Politano-Leadbetter technique with pneumovesicum is safe and effective for ureteric reimplantation and is comparable to the open approach.

Survey of Current Status and Cognition of Activities of Daily Living in Dementia Patients: the 2018 "Il-sang-ye-chan" Campaign

BACKGROUND AND PURPOSE

Disability associated with activities of daily living (ADL) is the basis of dementia diagnosis and is an important factor in the care of dementia patients. The status of awareness and burden of ADL disability in dementia patients was investigated six years ago and used as an important reference for "Il-sang-ye-chan" campaign. They were re-investigated in six years and compared with previous results.

METHODS

The survey included caregivers of 100 dementia patients listed at the four regional dementia centers. Structured open and closed questions about ADL were asked. Assessments included age, sex, education level, economic status, severity of dementia, caregiving pattern, current statues and cognition of ADL, and caregiver needs.

RESULTS

The cognition of ADL was still very low (43%). Increased stress among caregivers was the biggest burden, and they frequently suffered from outing disability (56%), recent memory loss (48%), and loss of bowel/bladder control (40%). The economic burden has been greatly reduced compared with the burden six years ago and the needs of caregivers were still highly about educational guide lines or programs.

CONCLUSIONS

Continued interest and further investigation into ADL disability of dementia patients are needed. Korean Dementia Association will further expand the "Il-sang-ye-chan" program: via a multi-domain cognitive intervention program under the Care for ADL in dementia and Relieve symptoms in Dementia Project.

Mixed Infection with Severe Fever with Thrombocytopenia Syndrome Virus and Two Genotypes of Scrub Typhus in a Patient, South Korea, 2017

Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral disease with a high mortality rate. Infection can also occur through close contact with an infected patient. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a bacterium transmitted to humans through chigger mite bites. South Korea is an endemic region of SFTS and scrub typhus. In this study, we confirmed that a patient was coinfected with SFTS virus and two (Boryong and Taguchi) genotypes of O. tsutsugamushi.

Initial experiences of laparoscopic intravesical detrusorraphy using the Politano-Leadbetter technique

INTRODUCTION

Minimally invasive laparoscopic surgical procedures are increasingly being used for the management of vesicoureteral reflux.

OBJECTIVE

We present our experience of the laparoscopic Politano-Leadbetter technique performed under pneumovesicum conditions, which allows an orthotopic ureteral location after vesicoureteral reflux correction. Our procedure recreates the new ureteric orifice in a normal anatomical position with potential less morbidity and better cosmesis.

STUDY DESIGN

Our series comprises ten cases. The three 5 mm ports were introduced through bladder wall under cystoscopic vision. A 5-0 monofilament traction suture was used and dissection was carried out. After the ureteral mobilization, the location of the new hiatus was selected in a straight line superior to the original orifice. Dissection of the submucosal tunnel was started from the new hiatus and advanced to the original hiatus and the ureter was gently drawn passed through the tunnel. The ureter was rolled up and muscle fibers were incised until ureter could freely move from the base of the new hiatus. Finally, after spatulation of the terminal part of the ureter, ureterovesical anastomosis was performed with intracorporeal suturing using 5-0 monofilament sutures.

RESULTS

The average operative time was 125 min, with an average of 93 min for unilateral and 133 min for bilateral reimplantation. Blood loss was minimal and drains were used selectively. Removal of urethral catheter was decided empirically after hematuria stopped. Mean catheterization time was 5.1 days. The mean postoperative hospital stay was 6.2 days.

DISCUSSION

This study had limitations: the small number of cases, follow-up period is relatively short and data on the pre-operative bladder capacity, catheter-related morbidity, pain control and cosmesis are lacking. But most cases showed positive clinical results including acceptable operating time and good resolution rate with minimal complication. Our Politano-Leadbetter transvesicoscopic ureteric reimplantation is safe and useful in the resolution of VUR, even though the laparoscopic ureteric reimplantation is technically demanding even for experienced pediatric surgeons. Considering the main advantages of endoscopic surgery, our new vesicoscopic technique could be an optional treatment to the open reimplantation and has merits because whole the procedure are performed within the bladder, so there is no risk of intraperitoneal organ injury.

CONCLUSION

Though the role of this new technique in the treatment of VUR remains to be determined, the technique could be an optional treatment to replace other surgical methods as a less invasive and effective therapeutic method.

Body composition is more closely related to the development of knee osteoarthritis in women than men: a cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1, 2)

OBJECTIVE

To evaluate the association between knee osteoarthritis (OA) and body composition parameters, and to analyze the correlations of both obesity and lower extremity muscle mass with radiographic knee OA in relation to sex.

METHODS

This was a cross-sectional study using data on body composition parameters measured using dual energy X-ray absorptiometry in 4246 participants in the Fifth Korea National Health and Nutrition Examination Survey. The relationships between knee OA and body composition parameters were evaluated. The associations between knee OA and the four subgroups corresponding to obesity and muscle mass percentage in both lower extremities were analyzed separately for each sex.

RESULTS

The lower extremity muscle mass showed a decreasing trend, while fat parameters showed an increasing linear trend (P for trend <0.05) with increasing severity of knee OA in women. The odds ratio of each quarter percentile group (25 percentile) for fat parameters showed an increasing trend, while that of the lower extremity muscle mass showed a decreasing linear trend in relation to knee OA in women (P for trend < 0.05). In women, low percentage of lower extremity muscle mass was more associated with knee OA regardless of obesity (P < 0.05). However, there were no associations between all body composition parameters and knee OA in men.

CONCLUSION

In women, high fat mass and low lower extremity muscle mass were associated with presence and severity of knee OA. Lower extremity muscle mass was more closely correlated with knee OA than obesity in women.

The influence of surgical factors on dislocation of the meniscal bearing after Oxford medial unicompartmental knee replacement: a case-control study

The aim of this study was to evaluate the risk factors for dislocation of the bearing after a mobile-bearing Oxford medial unicompartmental knee replacement (UKR) and to test the hypothesis that surgical factors, as measured from post-operative radiographs, are associated with its dislocation From a total of 480 UKRs performed between 2001 and 2012, in 391 patients with a mean age of 66.5 years (45 to 82) (316 female, 75 male), we identified 17 UKRs where bearing dislocation occurred. The post-operative radiological measurements of the 17 UKRs and 51 matched controls were analysed using conditional logistic regression analysis. The post-operative radiological measurements included post-operative change in limb alignment, the position of the femoral and tibial components, the resection depth of the proximal tibia, and the femoral component-posterior condyle classification. We concluded that a post-operative decrease in the posterior tibial slope relative to the pre-operative value was the only significant determinant of dislocation of the bearing after medial Oxford UKR (odds ratio 1.881; 95% confidence interval 1.272 to 2.779). A post-operative posterior tibial slope < 8.45° and a difference between the pre-operative and post-operative posterior tibial slope of > 2.19° may increase the risk of dislocation.

A modified laparoscopic ureterolithotomy by pulling ureter with Carter-Thomason fascial closure and ureter incision by broken 15th blade

BACKGROUND AND AIMS

To evaluate the efficacy and safety of a modified laparoscopic ureterolithotomy for the treatment of upper ureteral stones; this method involved the use of a Carter-Thomason fascial closure device, a broken 15th blade.

MATERIAL AND METHODS

From February 2009 to December 2012, 38 patients with unilateral upper ureteral stones were examined and classified into 2 groups: one group underwent conventional laparoscopic ureterolithotomy (n = 21) and the other group underwent modified laparoscopic ureterolithotomy (n = 17). The modified laparoscopic ureterolithotomy consisted of the use of a Carter-Thomason fascial closure to extract the black silk along with the nylon tape. The ureter incision was made with a modified instrument consisting of a needle holder with a broken 15th blade tip.

RESULTS AND CONCLUSIONS

Patient demographics were similar in both groups. No significant differences were detected between the conventional laparoscopic ureterolithotomy and modified laparoscopic ureterolithotomy groups with respect to operating time, estimated blood loss, and stone clearance rates. Drain-indwelling times were significantly shorter in modified laparoscopic ureterolithotomy patients than in conventional laparoscopic ureterolithotomy patients (3.2 ± 1.3 vs 4.7 ± 1.5 days). Hospital stay was significantly lesser in modified laparoscopic ureterolithotomy patients than in conventional laparoscopic ureterolithotomy patients (4.3 ± 1.2 vs 5.2 ± 1.2 days). No differences were detected in the ureteral stent indwelling time for the two groups. The use of the Carter-Thomason fascial closure facilitated ureter handling, and the use of a needle holder with a broken 15th blade tip enabled a sharp and precise ureteral incision. Our method allows early removal of the drain and thus earlier patient discharge.

Effect of temperature on the treatment of domestic wastewater with a staged anaerobic fluidized membrane bioreactor

A laboratory staged anaerobic fluidized membrane bioreactor (SAF-MBR) system was applied to the treatment of primary clarifier effluent from a domestic wastewater treatment plant with temperature decreasing from 25 to 10 °C. At all temperatures and with a total hydraulic retention time of 2.3 h, overall chemical oxygen demand (COD) and biochemical oxygen demand (BOD5) removals were 89% and 94% or higher, with permeate COD and BOD5 of 30 and 7 mg/L or lower, respectively. No noticeable negative effects of low temperature on organic removal were found, although a slight increase to 3 mg/L in volatile fatty acids concentrations in the effluent was observed. Biosolids production was 0.01-0.03 kg volatile suspended solids/kg COD, which is far less than that with aerobic processes. Although the rate of trans-membrane pressure at the membrane flux of 9 L/m(2)/h increased as temperature decreased, the SAF-MBR was operated for longer than 200 d before chemical cleaning was needed. Electrical energy potential from combustion of the total methane production (gaseous and dissolved) was more than that required for system operation.

Germline mutations and genotype-phenotype correlations in patients with apparently sporadic pheochromocytoma/paraganglioma in Korea

The aim of our study was to assess the frequency of germline mutations and develop the genetic testing strategy in patients with apparently sporadic pheochromocytoma/paraganglioma (PPGL) in Korea. We included 53 patients diagnosed with non-syndromic PPGL without a family history of PPGLs in three referral centers from 2004 to 2011. Succinate dehydrogenase complex B (SDHB), SDHD, Von Hippel-Lindau (VHL), and rearranged during transfection (RET) genes were examined by direct sequencing and multiple ligation-dependent probe amplification. The study patients were composed of 26 men and 27 women, and mean age was 50.1 ± 13.5 years. The frequency of germline mutations was 13.2% (7/53): RET (n = 2), VHL (n = 1), SDHB (n = 2), and SDHD (n = 2). Six of seven mutation carriers were diagnosed before the age of 50. One of two patients harboring an SDHB mutation had malignant PPGLs. One patient with multifocal head and neck paraganglioma (PGL) and pheochromocytoma (PHEO) carried a SDHD mutation. The carriers of germline mutations in patients with apparently sporadic PPGL were 13.2% in our study. We recommend genetic testing in patients below 50 years and SDHD genetic testing in patients with multifocal PPGLs. In malignant PPGLs, SDHB genetic testing may be performed.

The association between the self-perception period of overactive bladder symptoms and overactive bladder symptom scores in a non-treated population and related sociodemographic and lifestyle factors

AIMS

To investigate the association between the self-perception period of OAB symptoms (SP-OAB) and the overactive bladder symptom score (OABSS), along with related sociodemographic and lifestyle factors.

METHODS

This was a cross-sectional study comprised of 192 men aged 40 years and older who participated in a prostate examination survey between February and May 2009 and proved to have OAB. Survey questionnaires included items on the OABSS and the SP-OAB assessed by the OABSS. Various sociodemographic and lifestyle factors were also included.

RESULTS

The average SP-OAB period was 24.72 ± 45.75 months and became significantly longer as the severity of OAB increased in correlation analysis (coefficient = 0.501, p < 0.001). Age, education, income, regular check-up, health maintenance and occupation were all risk factors in both OABSS and SP-OAB in univariate analysis. Body mass index (BMI), family size and SP-OAB were risk factors for OABSS in univariate analysis. Age and regular check-ups were factors in both OABSS and SP-OAB in multivariate analysis. BMI, income and SP-OAB were risk factors for OABSS.

CONCLUSION

These findings suggest that the SP-OAB is an independent risk factor for OAB progression and that various sociodemographic and lifestyle factors affect OABSS. The self-perception period should be considered in the treatment and prevention of OAB symptoms.

Sociodemographic and lifestyle factors affecting the self-perception period of lower urinary tract symptoms of international prostate symptom score items

AIMS

This study investigated the influence of sociodemographic and lifestyle factors on the lower urinary tract symptom (LUTS) self-perception period and International Prostate Symptom Score.

METHOD

This cross-sectional study examined 209 men aged ≥ 40 years with non-treated LUTS who participated in a prostate examination survey. Questions included International Prostate Symptom Score (IPSS) items with self-perception periods for each item. Sociodemographic and lifestyle factors were also assessed. Participants were divided by mild LUTS (IPSS less than 8) and moderate-to-severe LUTS (IPSS 8 or higher).

RESULTS

Self-perception period of the moderate-to-severe LUTS (n = 110) was affected by BMI; the self-perception period of the mild LUTS (n = 90) was affected by age, income, occupation and concomitant disease. Moderate-to-severe LUTS were affected by self-perception period (p = 0.03). Self-perception period was affected by concern for health (p = 0.005) by multivariate analysis, and self-perception period of mild LUTS was affected by BMI (p = 0.012). Moderate-to-severe LUTS were affected by age, number of family members, concern for health and drinking (p < 0.05, respectively) by multivariate analysis.

CONCLUSION

Lower urinary tract symptom was affected by self-perception period. In moderate-to-severe LUTS, age, concern for health and drinking were affecting factors of self-perception period.

Treatment satisfaction with low-dose tamsulosin for symptomatic benign prostatic hyperplasia: results from a multicentre cross-sectional survey

AIMS

To evaluate the efficacy and treatment satisfaction with low-dose (0.2 mg) tamsulosin in patients with symptomatic benign prostatic hyperplasia (BPH), and to investigate individual lower urinary tract symptoms according to treatment satisfaction.

METHODS

A cross-sectional study was conducted in a total sample of 2574 patients from multiple centres. International Prostate Symptom Score (IPSS), prostate volume, uroflowmetry and combined medications were reviewed. Detailed questionnaires were used to assess treatment satisfaction and IPSS 8 weeks after treatment with low-dose tamsulosin.

RESULTS

After 8 weeks of treatment with low-dose tamsulosin, IPSS improved significantly. Among the 2574 patients, 1,630 (63.42%) were satisfied and 940 patients (36.50%) were dissatisfied with low-dose tamsulosin. The reasons for dissatisfaction included efficacy problems (84.66%) and side effects (3.72%). Treatment satisfaction was affected by symptom duration, baseline IPSS, and prostate size (p = 0.0441, < 0.001, < 0.009, respectively). IPSS voiding (IPSS-V) and IPSS storage (IPSS-S) after treatment differed significantly depending on the degree of satisfaction (p < 0.001). IPSS-V after treatment did not improve in patients who were 'not satisfied' or 'totally not satisfied' (p = 0.170, 0.240, respectively). All the individual IPSS items except urgency (p = 0.1436) varied significantly with the degree of satisfaction (p < 0.001).

CONCLUSIONS

Treating symptomatic BPH with low-dose tamsulosin improved IPSS, but more than one-third of patients were dissatisfied with the treatment. The main reason for dissatisfaction was efficacy problems, and the degree of satisfaction was related to symptom duration, baseline IPSS, and prostate size, and also to IPSS-V. In patients with severe LUTS, the tamsulosin dose should be increased earlier.

The relaxant effect of ginseng saponin on the bladder and prostatic urethra: an in vitro and in vivo study

AIM

To assess the effects of ginseng saponin on relaxation of the bladder and prostatic urethra and to determine its mechanism of action.

MATERIALS AND METHODS

For the in vitro study, prostatic urethra muscle strips were harvested from 18 male New Zealand rabbits. The strips were mounted in organ baths and connected to force displacement transducers. After stabilization, maximal tissue contractions were obtained by the application of phenylepinephrine to the urethra strips, and a dose-response curve for ginseng saponin was constructed (10(-6)-10(-2)M). After pretreatment of urethra strips with N-nitro-L-arginine methyl ester (L-NAME), another dose-response curve for ginseng saponin was constructed. For the in vivo study, we used adult male Sprague-Dawley rats divided into three groups [control, partial bladder outlet obstruction (PBOO) and saponin-fed groups], and we monitored the vesical pressure (P(ves)) and urethral perfusion pressure (UPP).

RESULTS

The ginseng saponin induced a significant dose-dependent relaxant effect on the prostatic urethra strips. A significant relaxant effect of ginseng saponin was observed from 10(-3)M, and ginseng saponin significantly relaxed urethra strips by 50.2 ± 20.26% at 10(-2)M. The relaxant effect was partially inhibited with L-NAME pretreatment. In the in vivo study, the change in UPP between baseline and relaxation was significantly higher in the saponin group than in the control or PBOO group (p < 0.001). The saponin group showed a significantly lower baseline P(ves) than the PBOO group.

CONCLUSIONS

We observed a significant relaxation effect of ginseng saponin on the bladder and prostatic urethra in both in vitro and in vivo studies. The mechanism by which ginseng saponin induces relaxation appears to involve the nitric oxide/nitric oxide synthase pathway.

Correlation between immunocytochemistry of human papilloma virus L1 capsid protein and behavior of low-grade cervical cytology in Korean women

AIM

The aim of this study was to evaluate the behavior of low-grade squamous intraepithelial lesion (LSIL) in Korean women infected with human papillomavirus (HPV) in relation to the immunocytochemical detection of the HPV L1 capsid protein.

MATERIAL AND METHODS

From January 2006 to December 2007, a total of 353 immunocytochemistry tests were performed on specimens from HPV-infected patients with LSIL. Due to exclusions, the study population was reduced to 318. Subjects were monitored at 4-6 month intervals. The regression, persistence, and progression of the cytologic abnormalities of the 318 cases were compared with the results of HPV L1 capsid protein immunocytochemical detection.

RESULTS

Of the 137 patients negative for the HPV L1 capsid protein, 38 (27.7%) showed progression to high-grade lesions, 50 (36.5%) showed persistence, and 49 (35.8%) showed regression to normal cytological features. In contrast, of the remaining 181 patients positive for the HPV L1 capsid protein, 15 (8.3%) showed progression to high-grade lesions, 74 (40.9%) showed persistence, and 92 (50.8%) showed regression. The results of immunocytochemical testing for the HPV L1 capsid protein show a linear association with the progression or regression behavior of low-grade cervical cytology in patients infected with HPV (linear by linear association test, P<0.05).

CONCLUSION

Immunocytochemical detection of HPV L1 was significantly related with the biological patterns of LSIL in Korean women. Hence, immunocytochemistry for the detection of HPV L1 is beneficial in providing further information for LSIL.

Loading behavior of Pt nanoparticles on the surface of multiwalled carbon nanotubes having defects formed via microwave treatment

We developed a simple and efficient method to load Pt nanoparticles (NPs) uniformly on defects generated in multiwalled CNTs (MWCNTs) without using reduction agents or organic reagents. Defects on the surfaces of MWCNTs were artificially generated by microwave treatment at various exposure times. Nucleation of Pt NPs occurs on the defect sites spontaneously due to an innate electropotential difference. Because of the correlation between defects and Pt NPs, we were able to control the size of Pt NPs by changing defect size, quantity and distribution, which was confirmed by Raman spectroscopy and TEM. After microwave treatment for 3 min, more uniform and smaller Pt NPs were observed. Also, the defects via microwave treatment make adhesion of Pt NPs stronger, which can be helpful to improve the reliability for applications. Finally, the methanol oxidation behavior of MWCNTs with Pt NPs was examined by cyclic voltammetry (CV).

Substance P sensitizes P2X3 in nociceptive trigeminal neurons

Peripheral inflammation produces pain hypersensitivity by sensitizing nociceptors. Potentiation of P2X3 receptor activity in nociceptors may play an important role in this peripheral sensitization. However, we do not fully understand how P2X3 activity is elevated in inflammation. Thus, we investigated whether P2X3 activity in trigeminal nociceptive neurons is regulated by the neurokinin-1 (NK-1) receptor that is activated by an inflammatory mediator, substance P. Single-cell RT-PCR and immunohistochemistry revealed that NK-1 in nociceptive neurons was mainly co-expressed with P2X3. Ca(2+) imaging and whole-cell patch-clamp recordings indicated that both substance P and Sar-substance P, a selective NK-1 agonist, significantly potentiated α,β-meATP-induced currents and [Ca(2+)](i) responses in nociceptive neurons. These potentiating effects were completely blocked by GR82334, a specific NK-1 antagonist. Our results demonstrate that substance P sensitizes P2X3 receptor through the activation of NK-1, thus warranting these receptors as possible targets for pain therapy in the orofacial region.

ABBREVIATIONS

α,β-methylene adenosine 5'-triphosphate (ATP), α,β-meATP; neurokinin-1, NK-1; single-cell reverse-transcription polymerase chain-reaction, single-cell RT-PCR; [Sar(9),Met(O(2))(11)]-substance P, Sar-substance P.

The effects of intravesical chemoimmunotherapy with gemcitabine and Bacillus Calmette-Guérin in superficial bladder cancer: a preliminary study

This prospective study investigated the long-term effects of intravesical chemoimmunotherapy with gemcitabine (GEM) and bacillus Calmette-Guérin (BCG; n = 36) versus BCG alone (n = 51) for the treatment of superficial bladder cancer. For the chemoimmunotherapy (GEM + BCG) group, GEM (1000 mg) was instilled immediately after transurethral resection of bladder tumour (TURBT) and again (2000 mg) 1 week later. From 2 to 7 weeks after TURBT, BCG was instilled into the bladder of all patients once weekly. The recurrence-free period of the GEM + BCG group (24.13 months) was significantly longer than that of the BCG monotherapy group (19.81 months). The overall recurrence rate was similar between the groups, although at 6 and 9 months post-TURBT, GEM + BCG produced a significantly lower rate of recurrence compared with BCG alone. This study suggests that intravesical chemoimmunotherapy with GEM + BCG is effective in reducing early tumour recurrence and in prolonging the recurrence-free period of superficial bladder cancer.

Mucinous adenocarcinoma involving the ovary: comparative evaluation of the classification algorithms using tumor size and laterality

For intraoperative consultation of mucinous adenocarcinoma involving the ovary, it would be useful to have approaching methods in addition to the traditional limited microscopic findings in order to determine the nature of the tumors. Mucinous adenocarcinomas involving the ovaries were evaluated in 91 cases of metastatic mucinous adenocarcinomas and 19 cases of primary mucinous adenocarcinomas using both an original algorithm (unilateral >or=10 cm tumors were considered primary and unilateral <10 cm tumors or bilateral tumors were considered metastatic) and a modified cut-off size algorithm. With 10 cm, 13 cm, and 15 cm size cut-offs, the algorithm correctly classified primary and metastatic tumors in 82.7%, 87.3%, and 89.1% of cases and in 80.6%, 84.9%, and 87.1% of signet ring cell carcinoma (SRC) excluded cases. In total cases and SRC excluded cases, 98.0% and 97.2% of bilateral tumors were metastatic and 100% and 100% of unilateral tumors <10 cm were metastatic, respectively. In total cases and SRC excluded cases, 68.4% and 68.4% of unilateral tumors >or=15 cm were primary, respectively. The diagnostic algorithm using size and laterality, in addition to clinical history, preoperative image findings, and operative findings, is a useful adjunct tool for differentiation of metastatic mucinous adenocarcinomas from primary mucinous adenocarcinomas of the ovary.

CK7, CK20, CDX2 and MUC2 Immunohistochemical staining used to distinguish metastatic colorectal carcinoma involving ovary from primary ovarian mucinous adenocarcinoma

OBJECTIVE

Colorectal adenocarcinoma, the most common tumor that metastasizes to the ovary, is often difficult to distinguish from primary ovarian mucinous adenocarcinoma (POMA). Obtaining the correct diagnosis is difficult but crucial to treatment and prognosis.

METHODS

We evaluated the immunohistochemical (IHC) expression of cytokeratin 7 (CK7), cytokeratin 20 (CK20), CDX2, CEA, MUC2, MUC5AC and alpha-methylacyl-CoA racemase (AMACR) in 22 POMAs and 41 metastatic colorectal adenocarcinomas (MCAOs) involving ovaries.

RESULTS

MCAOs, in contrast with POMAs, were almost always negative for MUC5 (97.6%), often negative for CK7 (82.9%), focal or diffuse positive for CDX2 (73.2%), diffuse positive for CK20 (65.9%), focal or diffuse positive for MUC2 (51.2%), diffuse positive for CEA (41.5%) and negative for AMACR (41.5%). We therefore considered CK7 (-), CK20 (diffuse +), CDX2 (+) and MUC2 (+) to be colonic markers and regarded cases with expression of more than two colonic markers as MCAO, those with no expression of colonic markers as POMA and those with expression of one colonic marker as indeterminate. Using CK7/CK20/CDX2/MUC2, 82.5% of the cases were correctly classified, 6.3% were misclassified and 6.3% were indeterminate.

CONCLUSION

CK7, CK20, CDX2 and MUC2 IHC staining is a useful adjunctive diagnostic tool to differentiate MCAOs from POMAs, in addition to clinical history and gross and microscopic findings.

Arthrodesis of the knee using cannulated screws

We retrospectively evaluated eight patients who underwent arthrodesis of the knee using cannulated screws. There were six women and two men, with a mean age of 53 years. The indications for arthrodesis were failed total knee arthroplasty, septic arthritis, tuberculosis, and recurrent persistent infection. Solid union was achieved in all patients at a mean of 6.1 months. One patient required autogenous bone graft for delayed union. One suffered skin necrosis which was treated with skin grafting. The mean limb-length discrepancy was 3.1 cm. On a visual analogue scale, the mean pain score improved from 7.9 to 3.3. According to the Knee Injury and Osteoarthritis Outcome score quality of life items, the mean score improved from 38.3 pre-operatively to 76.6 at follow-up. Cannulated screws provide a high rate of union in arthrodesis of the knee with minimal complications, patient convenience, and a simple surgical technique.

Adjuvant therapy in high-risk early endometrial carcinoma: a retrospective analysis of 46 cases

OBJECTIVE

We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma.

METHODS

One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments.

RESULTS

One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%).

CONCLUSION

Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.

The effect of bupivacaine.HCl on the physical properties of neuronal membranes

Fluorescent probe techniques were used to evaluate the effect of bupivacaine.HCl on the physical properties (transbilayer asymmetric lateral and rotational mobilities, annular lipid fluidity and protein distribution) of synaptosomal plasma membrane vesicles (SPMVs) isolated from bovine cerebral cortex. An experimental procedure was used based on selective quenching of both 1,3-di(1-pyrenyl)propane (Py-3-Py) and 1,6-diphenyl-1,3,5-hexatriene (DPH) by trinitrophenyl groups, and radiationless energy transfer (RET) from the tryptophans of membrane proteins to Py-3-Py. Bupivacaine.HCl increased the bulk lateral and rotational mobilities, and annular lipid fluidity in SPMVs lipid bilayers, and had a greater fluidizing effect on the inner monolayer than that of the outer monolayer. The magnitude of increasing effect on annular lipid fluidity in SPMVs lipid bilayer induced by bupivacaine.HCl was significantly far greater than magnitude of increasing effect of the drug on the lateral and rotational mobilities of bulk SPMVs lipid bilayer. It also caused membrane proteins to cluster. These effects of bupivacaine.HCl on neuronal membranes may be responsible for some, though not all, of the local anesthetic actions of bupivacaine.HCl.

Predictors of slow flow during primary percutaneous coronary intervention: an intravascular ultrasound-virtual histology study

OBJECTIVES

Slow flow phenomenon is a serious complication of percutaneous coronary intervention (PCI) and is associated with a poor prognosis. We sought to evaluate the characteristics of lesions predisposing to the slow/no-reflow phenomenon during primary PCI in patients with acute myocardial infarction.

METHODS

The study subjects consisted of 57 consecutive patients (mean age 58.5 (SD 14.5) years, 45 males) who underwent primary PCI for acute myocardial infarction and intravascular ultrasound-virtual histology (IVUS-VH) examination. Slow flow was defined as <or= thrombolysis in myocardial infarction grade 2 after PCI.

RESULTS

Slow flow developed in 12 patients (eight males). Patients with slow flow were likely to be older (67.5 (13.8) years vs 56.2 (13.9) years, p = 0.015), had more cardiogenic shock (16.7% vs 2.2%, p = 0.046), larger fibrofatty volume over the entire lesion length (36.7 (25.5) mm(3) vs 18.0 (18.6) mm(3), p = 0.006), higher remodelling index (1.10 (0.17) vs 0.99 (0.16), p = 0.043), larger plaque area (16.2 (5.4) mm(2) vs 12.5 (4.9) mm(2), p = 0.025), fibrous area (8.0 (3.3) mm(2) vs 5.4 (3.0) mm(2), p = 0.014) and fibrofatty area (2.7 (2.2) mm(2) vs 1.3 (1.6) mm(2), p = 0.016) at the minimal lumen site than those without slow flow (37 males). Multivariate analysis revealed that the fibrofatty volume over the entire lesion length was the only independent factor (beta = 0.359, 95% confidence interval 0.002 to 0.012, p = 0.006) for slow flow during primary PCI.

CONCLUSIONS

This study suggests that slow flow may be dependent on the tissue characterisation (fibrofatty volume) of the underlying lesion at the time of the primary PCI for acute myocardial infarction.

The increasing frequency of cervical cancer in Korean women under 35

PURPOSE

The goal of this study was to determine the clinical and epidemiological trends of cervical cancer in young Korean women. Social behavior including sexual habits has changed in Korean women, with sexual activity commencing at a younger age. These changes are likely to influence certain risk factors of cervical cancer, resulting in changing trends in the occurrence of the disease.

MATERIALS AND METHODS

The incidence of cervical cancer in women less than 35 years-old between January 1990 and December 2006 was analyzed, and available medical records from January 1996 to December 2006 were reviewed. The clinical, pathological and epidemiologic characteristics and changing trends among these young patients were analyzed.

RESULTS

Over the last two decades, the incidence of young (< 35 years) cervical cancer patients increased, more patients had an aggressive form of the disease, and there was a higher rate of women with more advanced education. Human papillomavirus (HPV) infection was detected in 94.0% of the women (63/67) tested. HPV 16 (82.5%) and HPV 18 (12.7%) were the two most common viral infections detected throughout the study period.

CONCLUSIONS

The changing trends and risk factors identified suggest a need for more active education of young women about cervical cancer prevention strategies. In addition, young women are strongly recommended to undergo a regular screening test and HPV vaccination.

The performance of the sludge pretreatment system with venturi tubes

This research investigates the feasibility of the venturi cavitation system (VCS) for the sludge pretreatment to increase biodegradability. The performances of the VCS depended on the inclination angle of the venturi outlet, and better results obtained with 12 degrees than with 8 degrees or 15 degrees . Although it is energy efficient to use several venturies in series, the number of the venturies should be determined with detailed fluid dynamic calculations. The linear relationship between total solid (TS) concentration and the increases in soluble chemical oxygen demand (Delta SCOD) was observed for both wasted activated sludge (WAS) and primary sludge, which might be related to the better conditions for cavitation development at high TS concentrations even with higher viscosity. The VCS achieved better energy efficiency in terms of Delta SCOD/kJ compared to high-speed homogenizer (HSH). On the other hand, the VCS showed a similar energy efficiency for mixed sludge with 1.8% TS, but lower efficiency for WAS with 4% TS when compared to ultrasonic disintegration.

Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure

We aimed to investigate whether postconization human papillomavirus (HPV) DNA testing can predict treatment failure and improve the accuracy of conventional follow-up in women with high-grade cervical intraepithelial neoplasia (CIN). Between March 2001 and October 2005, 120 patients with confirmed CIN 2 or 3 were treated with loop electrosurgical excision procedure (LEEP) and were enrolled. Six patients were lost to the follow-up. Postconization follow-up was performed at every 3–6 months during the first year and then annually. Specimens were tested for the presence of HPV, using the Hybrid Capture 2 (Digene Co, Gaithersburg, MD) and HPV DNA chip (Mygene Co, Seoul, Korea) test. Persistent HPV infection was defined as persistently (two times or more) positive HPV tests with the same HPV subtype(s) at initial diagnosis. Twenty-two (19.3%) patients showed treatment failure after conization. The only significant risk factor for redevelopment of CIN after conization was persistence of the same HPV subtype (P< 0.0001). And women with recurrent or residual CIN had higher HPV load during the 6-month follow-up postconization. In conclusion, the persistence of the same HPV subtype after LEEP conization was an important predictor of treatment failure. The follow-up protocol after conization of CIN should include both cervical cytology and HPV test, and HPV DNA chip test is needed to detect a persistent HPV infection.

The Effects of Long-Term Administration of Oral Desmopressin on the Baseline Secretion of Antidiuretic Hormone and Serum Sodium Concentration for the Treatment of Nocturia: A Circadian Study

PURPOSE

We assessed the effects of long-term oral desmopressin on serum sodium and baseline antidiuretic hormone secretion in elderly patients with nocturia.

MATERIALS AND METHODS

A total of 15 elderly male patients with severe nocturia (greater than 3 voids nightly) who did not show hyponatremia within 7 days of administration of 0.2 mg desmopressin were enrolled in this study. Desmopressin (0.2 mg) was administered orally nightly for 1 year. Before and 1 month after the 1-year medication 24-hour circadian studies were performed to monitor changes in antidiuretic hormone. Every 3 months during the 1-year medication serum changes and timed urine chemistry were monitored.

RESULTS

Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes (p<0.01). Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinically significant hyponatremia after 6 months of treatment. After discontinuing desmopressin serum sodium returned to the normal range in all patients. There were no significant differences when baseline and posttreatment endogenous antidiuretic hormone were compared. No serious systemic complications were found during medication.

CONCLUSIONS

Long-term desmopressin administration gradually decreased the serum concentration and induced significant hyponatremia from 6 months in patients who did not show initial hyponatremia. Long-term administration of desmopressin for 1 year in elderly patients did not affect baseline antidiuretic hormone secretion. For long-term desmopressin administration serum sodium should be assessed regularly, at least every 6 months.

Treatment of ovarian cancer with paclitaxel- or carboplatin-based intraperitoneal hyperthermic chemotherapy during secondary surgery

OBJECTIVE

We aimed to evaluate the efficacy and feasibility of treating advanced ovarian cancer with paclitaxel or carboplatin in intraperitoneal hyperthermic chemotherapy (IPHC) during secondary surgery.

METHODS

We reviewed clinical data of 96 eligible patients with stage Ic-IIIc epithelial ovarian cancer. After primary staging operation and 6-12 cycles of adjuvant chemotherapy, 22 patients were treated with IPHC-paclitaxel (175 mg/m(2)) and 45 patients were treated with IPHC-carboplatin (350 mg/m(2)) during secondary surgery. Survival rates were compared with those of 29 patients treated with only conventional therapy (control group).

RESULTS

In stage III diseases, 5-year survival rates were 84.6% in IPHC-paclitaxel, 63.0% in IPHC-carboplatin (P=0.4098) and 32.8% in control group (vs. IPHC, P=0.0003). Three-year progression-free survival rates in stage III diseases were both 56.3% in IPHC-paclitaxel and IPHC-carboplatin (P=0.8911) and 16.7% in control group (vs. IPHC, P=0.0028). For the relative risk of disease progression yielded from multivariate analyses, hazard ratio of IPHC-paclitaxel was 0.281 (P=0.0039) and that of IPHC-carboplatin was 0.443 (P=0.0083). Like carboplatin (hazard ratio: 0.396, P=0.0004), IPHC-paclitaxel considerably decreased the risk of death (hazard ratio: 0.197, P=0.0253).

CONCLUSION

In advanced ovarian cancer, IPHC using paclitaxel or carboplatin during secondary surgery could be a candidate for regional consolidation therapy to prolong survival and hinder disease progression.

Effect of tacrolimus on the production of oxygen free radicals in hepatic mitochondria

OBJECTIVES

Cyclosporine (CsA) causes side effects that occur mainly in the kidney but also in the liver. Several reports have strongly suggested that the production of oxygen free radicals (OFRs) is a common mechanism of CsA toxicity. However, tacrolimus is believed to suppress the production of OFRs.

METHODS

We obtained the mitochondrial fraction with 96% purity from rat liver using a sucrose density gradient solution. Zero to 100 micromol/L tacrolimus was incubated with the mitochondrial fraction for 6 hours at 37 degrees C. OFRs were evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2,7-dichlorefluorescein using a VICTOR3 multilabel counter.

RESULTS

The fluorescence units for OFR production were increased as the time of exposure to tacrolimus passed from 1 to 6 hours. The fluorescence units in 0.1 micromol/L tacrolimus were 6.0 x 10(5) at 1 hour, 7.8 x 10(5) at 2 hours, 9.0 x 10(5) at 3 hours, 10.0 x 10(5) at 4 hours, 11.1 x 10(5) at 5 hours, and 11.4 x 10(5) at 6 hours. However, the fluorescence units were similar although the tacrolimus concentration increases from 0.1 to 100 micromol/L.

CONCLUSIONS

The results in this experiment suggested that tacrolimus induced the production of OFRs depending on the exposure time.

Effects of cyclosporine and tacrolimus on the oxidative stress in cultured mesangial cells

OBJECTIVES

Cyclosporine (CsA) and tacrolimus (Tac) are two primary immunosuppressive agents used for the prevention of graft rejection. However, their use is associated with significant side effects, most notably nephrotoxicity. The mechanisms of this toxicity are not fully understood, but they seem to be associated with increases in the production of oxygen free radicals (OFRs). This present work examined the effect of CsA and Tac on the production of OFRs in cultured rat renal mesangial cells (RMCs).

METHODS

Varying concentrations of CsA and Tac (0 to 40 micromol/L) were added to RMCs and incubated for 60 minutes at 37 degrees C. The production of OFRs was evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2', 7'-dichlorofluorescin.

RESULTS

At 60 minutes, the relative fluorescence units (RFU) for OFRs production in RMCs exposure to CsA were increased by 2.5%, 11.5%, 22.5%, 57.2%, and 174% at 2.5, 5, 10, 20, and 40 micromol/L, respectively. Tac increased the RFU by 15.9%, 13.6%, 14.8%, 13.2%, 21.4%, 13.2%, and 28.1% at 0.1, 1, 2.5, 5, 10, 20, and 40 micromol/L, respectively. In RMCs, the RFU produced by CsA was higher than that by Tac.

CONCLUSIONS

The results of this experiment suggest that CsA and Tac induced renal injury by OFRs.

Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes

OBJECTIVES

To identify parameters influencing the likelihood of restenosis after implantation of drug-eluting stents (DES) in patients with diabetes.

METHODS

Stented patients (n = 840) with DES were retrospectively reviewed for inclusion in the study from the Multicenter PCI Database Registry. From this database, 211 (25.1%) of 840 patients with six-month angiographic follow up had diabetes. Predictors of coronary restenosis were identified with univariate and multivariate logistic regression analyses.

RESULTS

Restenosis occurred in 92 of 629 (14.6%) patients without diabetes and in 44 (20.9%) of 211 patients with diabetes (p < 0.001). Multivariate parameters for predicting restenosis in the diabetic group were current smoking (odds ratio (OR) 1.923, 95% confidence interval (CI) 1.055 to 4.725, p = 0.036), higher C reactive protein concentration (OR 1.031, 95% CI 1.011 to 1.075, p = 0.043), use of the paclitaxel-eluting stent (OR 2.638, 95% CI 1.338 to 5.200, p = 0.005), longer stent length (OR 1.065, 95% CI 1.021 to 1.119, p = 0.033), smaller reference diameter before DES implantation (OR 0.501, 95% CI 0.110 to 0.965, p = 0.040), smaller reference diameter (OR 0.455, 95% CI 0.120 to 0.814, p = 0.026) and minimum lumen diameter (OR 0.447, 95% CI 0.068 to 0.876, p = 0.039) after DES implantation.

CONCLUSION

Even with the introduction of DES, diabetes remains a significant predictor of coronary restenosis, especially in cases of a small baseline vessel size, small vessel size after percutaneous coronary intervention, longer stent length, use of the paclitaxel-eluting stent, current smoking and high C reactive protein concentration.

Origin of lumbar spinal roots and their relationship to intervertebral discs: a cadaver and radiological study

Previous studies on the anatomy of the lumbar spine have not clarified the precise relationship of the origin of the lumbar roots to their corresponding discs or their angulation to the dural sac. We studied 33 cadavers (25 formalin-preserved and eight fresh-frozen) and their radiographs to determine these details. All cadavers showed a gradual decrease in the angle of the nerve root from L1 to S1. The origin of the root was found to be below the corresponding disc for the L1 to L4 roots. In the formalin-preserved cadavers 8% of the L5 roots originated above, 64% below and 28% at the L4/L5 disc. In the fresh cadavers the values were 12.5%, 62.5% and 25%, respectively. For the S1 root 76% originated above and 24% at the L5-S1 disc in the formalin-preserved cadavers and 75% and 25%, respectively, in the fresh cadavers.A herniated disc usually compresses the root before division of the root sleeve. Thus, compression of the thecal sac before the origin of the root sleeve is common for L1 to L5 whereas compression at the root sleeve is common for S1. Our findings are of value in understanding the pathophysiology of prolapse of the disc and in preventing complications during surgery.

Effects of polyhemoglobin-antioxidant enzyme complex on ischemia-reperfusion in kidney

INTRODUCTION

The kidney suffers ischemia-reperfusion (I/R) injury during transplantation. The purpose of the present study was to investigate the therapeutic effect of artificials cells on renal I/R injury through biochemical assays and histological examination.

METHODS

We prepared artificial cells using cross-linked hemoglobin (Hb), superoxide dismutase (SOD), and catalase. Normal male Sprague-Dawley rats were divided into 6 groups: the sham-operated control group, the group treated with polyHb,and the group treated with polyHb-SOD-catalase (PSC) (per groups were subjected to ischemia for 1 hour or 2 hours). After reperfusion for 4 hours, kidney and blood samples were obtained.

RESULTS

The levels of SOD and catalase in the PSC group were 15 and 50 times higher than those of the control group, respectively. In the polyHb group, the levels of blood urea nitrogen (BUN), serum creatinine, renal hydrogen peroxide, and renal malondialdehyde were increased. However, their levels were significantly decreased by PSC administration. Renal SOD activity did not show any significant changes in the polyHb group, but renal catalase activity was decreased by polyHb treatment in comparison with the control group. The activities of renal SOD and catalase were increased using PSC treatment. In the histological findings, the PSC group showed no evidence of acute tubular necrosis in proximal convoluted tubules; their microvilli and cytoplasmic microorganelles were relatively well preserved.

CONCLUSIONS

These results show that PSC effectively reduces renal damage via diminished oxygen free radical-mediated injury after I/R.

Influenza vaccines: recent advances in production technologies

In spite of ongoing annual vaccination programs, the seasonal influenza epidemics remain a major cause of high morbidity and mortality. The currently used "inactivated" vaccines provide very short-term and highly specific humoral immunity due to the frequent antigenic variations in the influenza virion. These intra-muscularly administered vaccines also fail to induce protective mucosal immunity at the portal of viral entry and destruction of the virally infected cells by induction of cytotoxic T lymphocytes. Therefore, it is necessary to develop immunologically superior vaccines. This article highlights some of the recent developments in investigational influenza vaccines. The most notable recent developments of interest include the use of immunopotentiators, development of DNA vaccines, use of reverse genetics, and the feasibility of mammalian cell-based production processes. Presently, due to their safety and efficacy, the cold-adapted "live attenuated" vaccines are seen as viable alternatives to the "inactivated vaccines". The DNA vaccines are gaining importance due to the induction of broad-spectrum immunity. In addition, recent advances in recombinant technologies have shown the possibility of constructing pre-made libraries of vaccine strains, so that adequately preparations can be made for epidemics and pandemics.

Overexpression of short heterodimer partner recovers impaired glucose-stimulated insulin secretion of pancreatic beta-cells overexpressing UCP2

The short heterodimer partner (SHP) (NR0B2) is an orphan nuclear receptor whose function in pancreatic beta-cells is unclear. Mitochondrial uncoupling protein (UCP2) in beta-cells is upregulated in obesity-related diabetes, causing impaired glucose-stimulated insulin secretion (GSIS). We investigated whether SHP plays a role in UCP2-induced GSIS impairment. We overexpressed SHP in normal islet cells and in islet cells overexpressing UCP2 by an adenovirus-mediated infection technique. We found that SHP overexpression enhanced GSIS in normal islets, and restored GSIS in UCP2-overexpressing islets. SHP overexpression increased the glucose sensitivity of ATP-sensitive K+ (KATP) channels and enhanced the ATP/ADP ratio. A peroxisome proliferator-activated receptor gamma (PPARgamma) antagonist, GW9662, did not block the SHP effect on GSIS. SHP overexpression also corrected the impaired sensitivity of UCP2-overexpressing beta-cells to methylpyruvate, another energy fuel that bypasses glycolysis and directly enters the Krebs cycle. KATP channel inhibition mediated by dihydroxyacetone, which gives reducing equivalents directly to complex II of the electron transport system, was similar in Ad-Null-, Ad-UCP2- and Ad-UCP2+Ad-SHP-infected cells. The mitochondrial metabolic inhibitor sodium azide totally blocked the effect of SHP overexpression on GSIS. These results suggest that SHP positively regulates GSIS in beta-cells and restores glucose sensitivity in UCP2-overexpressing beta-cells by enhancing mitochondrial glucose metabolism, independent of PPARgamma activation.

Effect of artificial cells on hepatic function after ischemia–reperfusion injury in liver

BACKGROUND

The liver suffers from ischemia/reperfusion injury during transplantation. Reactive oxygen species generated by xanthine oxidase during reperfusion of the ischemic liver may be partially responsible for the hepatic injury. Oxygen free radicals are removed by antioxidant enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase. Using glutaraldehyde and lysine we constructed crosslinked hemoglobin, containing SOD and catalase, and assessed its ability to protect against ischemia/reperfusion injury during transplantation.

METHODS

In contrast to the sham-operated control groups, blood was exchanged using crosslinked hemoglobin (polyHb) a PolyHb-SOD-catalase (PSC) group. After ischemia/reperfusion injury, several parameters of hepatic damage and oxygen free radicals were measured as well as microscopic examination.

RESULTS

Alanine aminotransferase, aspartate aminotransferase, superoxide production, hydrogen peroxide, and malondialdehyde levels were higher among the PolyHb group than sham-operated controls. The PolyHb group revealed a few apoptotic bodies, some acute inflammatory infiltrates in the sinusoids, nuclear fragmentations, cell shrinkage, and chromatin clumping with formation of apoptotic bodies in the apoptotic cells under microscopic examination. Alanine aminotransferase, aspartate aminotransferase, superoxide production, and hydrogen peroxide levels were lower in the PSC than the PolyHb group. Hepatic structures were well preserved in the PSC group.

CONCLUSIONS

Reactive oxygen species contribute to hepatic dysfunction with morphologic changes. PSC is effective to reduce hepatic damage by lowering oxygen free radical-mediated injury after ischemia/reperfusion in the liver.

Treatment of landfill leachate by a pilot-scale modified Ludzack-Ettinger and sulfur-utilizing denitrification process

Nitrogen removal efficiency of a pilot-scale system consisted of Modified Ludzack-Ettinger (MLE) followed by sulfur-utilizing denitrification (SUDNR) process was evaluated with a landfill leachate. For SUDNR, a down-flow mode sulfur packed bed reactor (SPBR) filled with sulfur and limestone particles was used. Although total nitrogen removal efficiency of the MLE process was about 80% at the recycle ratio of 4, effluent contained 350-450 mg/L NO(3-)-N. Up to a loading rate of 1.2 kg NO(3-)-N/m3-day, the SPBR could achieve complete removal of nitrate, and nitrate removal rate was kept to that level even at higher loading rate. When a COD/N ratio of MLE process was maintained at 2 instead of 4, more organics with molecular weight less than 500 were utilized for heterotrophic denitrification although denitrification was not complete with the lack of electron donors. Clogging in the SPBR, mainly by the accumulation of nitrogen gas in the pores, could easily be removed by introducing the effluent in an upward direction for 1 min at 1 hr intervals. The proposed treatment system could achieve nitrate free effluent with a slight increase in chemical cost. Furthermore, depending on further COD removal requirement after biological treatment, the proposed treatment system can be an economical solution.