Exoskeleton-assisted Gait Training in Spinal Disease With Gait Disturbance / 대한신경손상학회지

Objective@#Gait impairment reduces a patient’s quality of life. Exoskeletons and wearable robotics enable patients with gait disturbance to stand up and walk. An exoskeleton was developed for use in patients with stroke and spinal cord injuries. This study aimed to evaluate the effectiveness of overground exoskeleton-assisted gait training (OEGT) in spine diseases with gait disturbance. @*Methods@#This was a single-group preliminary study. Five participants with gait disorders because of root dysfunction accompanying spinal stenosis were included in this study. All participants underwent surgical treatment and an exoskeleton training protocol scheduled for 2 or 3 days per week for 4 weeks. Each session was 60 minutes. Clinical tests were performed before (T1) and at the end of the training (T2). @*Results@#One patient dropped out of the study because of medical issues that were not associated with the exoskeleton. Exoskeleton-assisted rehabilitation was feasible for all participants. All participants showed positive changes in gait performance, balance, proximal muscle strength, psychological state, and satisfaction with the rehabilitation. However, there was no significant improvement in neurological deficits. @*Conclusion@#OEGT is a feasible rehabilitation method for patients with gait disorders caused by degenerative spinal disease.

Contralateral Interhemispheric Transcallosal Approach for Thalamic Cystic Cavernous Malformation

A 42-year-old man presented with a headache and right hemiparesis and was found to have a cystic mass with a calcified mural nodule in the left thalamus. Because the thalamus is surrounded by vital neurovascular structures, the surgical approach to thalamic lesions can be challenging. We decided to remove the mass for decompression and pathological diagnosis. The mass was removed through a contralateral interhemispheric transcallosal transchoroidal approach with less retraction and parenchymal injury than other approaches to avoid brain retraction and cortical injury. The pathological diagnosis was cavernous malformation. Temporary worsening of the preoperative hemiparesis was recovered over two months following surgery. Tolerable thalamic pain syndrome remained. Here, we report a rare case of thalamic cavernous malformation with a favorable outcome through a contralateral surgical approach.

Prognostic Significance of EPHB2 Expression in Colorectal Cancer Progression

BACKGROUND: A receptor tyrosine kinase for ephrin ligands, EPHB2, is expressed in normal colorectal tissues and colorectal cancers (CRCs). The aim of this study was to investigate EPHB2 expression over CRC progression and determine its prognostic significance in CRC. METHODS: To measure EPHB2 mRNA and protein expression, real-time polymerase chain reaction and immunohistochemistry were performed in 32 fresh-frozen and 567 formalin-fixed paraffin-embedded CRC samples, respectively. We further investigated clinicopathological features and overall and recurrence-free survival according to EPHB2 protein expression. RESULTS: The EPHB2 level was upregulated in CRC samples compared to non-cancerous tissue in most samples and showed a strong positive correlation with AXIN2. Notably, CD44 had a positive association with both mRNA and protein levels of EPHB2. Immunohistochemical analysis revealed no difference in EPHB2 expression between adenoma and carcinoma areas. Although EPHB2 expression was slightly lower in invasive fronts compared to surface area (p < .05), there was no difference between superficial and metastatic areas. EPHB2 positivity was associated with lymphatic (p < .001) and venous (p = .001) invasion, TNM stage (p < .001), and microsatellite instability (p = .036). Kaplan–Meier analysis demonstrated that CRC patients with EPHB2 positivity showed better clinical outcomes in both overall (p = .049) and recurrence-free survival (p = .015). However, multivariate analysis failed to show that EPHB2 is an independent prognostic marker in CRCs (hazard ratio, 0.692; p = .692). CONCLUSIONS: Our results suggest that EPHB2 is overexpressed in a subset of CRCs and is a significant prognostic marker.

FOXO1 Suppression is a Determinant of Acquired Lapatinib-Resistance in HER2-Positive Gastric Cancer Cells Through MET Upregulation / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Lapatinib is a candidate drug for treatment of trastuzumab-resistant, human epidermal growth factor receptor 2 (HER2)–positive gastric cancer (GC). Unfortunately, lapatinib resistance renders this drug ineffective. The present study investigated the implication of forkhead box O1 (FOXO1) signaling in the acquired lapatinib resistance in HER2-positive GC cells. MATERIALS AND METHODS: Lapatinib-resistant GC cell lines (SNU-216 LR2-8) were generated in vitro by chronic exposure of lapatinib-sensitive, HER2-positive SNU-216 cells to lapatinib. SNU-216 LR cells with FOXO1 overexpression were generated by stable transfection of a constitutively active FOXO1 mutant (FOXO1A3). HER2 and MET in SNU-216 LR cells were downregulated using RNA interference. The sensitivity of GC cells to lapatinib and/or cisplatin was determined by crystal violet assay. In addition, Western blot analysis, luciferase reporter assay and reverse transcription–polymerase chain reaction were performed. RESULTS: SNU-216 LR cells showed upregulations of HER2 and MET, but downregulation of FOXO1 compared to parental SNU-216 cells. FOXO1 overexpression in SNU-216 LR cells significantly suppressed resistance to lapatinib and/or cisplatin. In addition, FOXO1 negatively controlled HER2 and MET at the transcriptional level and was negatively controlled by these molecules at the post-transcriptional level. A positive crosstalk was shown between HER2 and MET, each of which increased resistance to lapatinib and/or cisplatin. CONCLUSION: FOXO1 serves as an important linker between HER2 and MET signaling pathways through negative crosstalks and is a key regulator of the acquired lapatinib resistance in HER2-positive GC cells. These findings provide a rationale for establishing a novel treatment strategy to overcome lapatinib resistance in a subtype of GC patients.

Markers for Screening Lynch Syndrome Are Reliable and Useful for Identifying the Specimen Mislabeling

BACKGROUND: During specimen processing in surgical pathology laboratories, specimen-related adverse events (SRAEs), such as mislabeling and specimen mixed-up might occur. In these situations, molecular techniques using short tandem repeat (STR) loci are required to identify the personal identity. Microsatellite instability (MSI) test is widely used for screening the hereditary non-polyposis colon cancer (Lynch syndrome) in surgical pathologies using polymorphic STR markers. We tried to evaluate the applicability of the MSI test for SRAEs. METHODS: We obtained 253 MSI test results to analyze the allele frequencies. After calibrating the estimated nucleotide lengths, we calculated the allele frequencies, a random match probability, and a likelihood ratio (LR) of three dinucleotide STR markers (D5S349, D17S250, and D2S123). RESULTS: The distribution of LR was 136.38 to 5,606,213.10. There was no case of LR10,000. Furthermore, the combined probability of identity was 9.23x10(-4) and the combined power of exclusion was 0.99908. CONCLUSIONS: Using the three STR markers that are recommended for MSI test, all the cases were positively identified in 1% range and about one-third cases showed high LR (>10,000). These results showed that MSI tests are useful to screen the personal identity in case of SRAE in pathology laboratories.

Treatment Response and Long Term Follow-up Results of Nonspecific Interstitial Pneumonia

The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse.

Expression of BamHI-A Rightward Transcripts in Epstein-Barr Virus-Associated Gastric Cancers / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: About 10% of all gastric cancers (GCs) are Epstein-Barr virus (EBV)-associated. However, the oncogene of EBV in gastric carcinogenesis has not yet been established. In the present study, we investigated the virus-derived transcripts in the EBV-infected GC cell line to explore the viral oncogene of EBV-positive GCs. MATERIALS AND METHODS: We used the SNU719 cell line, a naturally derived EBV-infected GC cell line. The individual expressed sequence tags from the cDNA libraries of SNU719 were searched against the mRNA subset extracted from the GenBank data base. Sequence reaction was carried out for the EBV-associated clones. Reverse transcription-polymerase chain reaction was performed after cells were partitioned into nuclear and cytoplasmic fractions. RESULTS: Using bioinformatic tools, we selected 13 EBV-associated clones from cDNA libraries of SNU719. By sequencing analysis, we revealed that they were all associated with RPMS1, one of the BamHI-A rightward transcripts (BART) of EBV. Some BART cDNAs such as RPMS1 and A73 are known to be translated into protein in vitro, and have been shown to have some biochemical functions relevant to tumorigenesis. But, presently, the BART transcripts were expressed only in the nucleus and not in the cytoplasm, arguing against their role as messenger RNAs. Some other BART transcripts expressed in GCs (BARF0, CST, vIL, BARF1, BLLF1, and BcLF1) were also extensively detected in the nucleus. CONCLUSION: BART transcripts are the predominant viral transcripts expressed in EBV-associated GCs, and they are located only in the nucleus. Therefore, it seems less likely that BART transcripts produce functional proteins to play a role in carcinogenesis of EBV-associated GCs.

Neuronal Excitatory Action of GABA on the Pelvic Ganglia

OBJECTIVE: In the central nervous system, gamma-aminobutyric acid (GABA) is well known to act as an inhibitory neurotransmitter by hyperpolarizing postsynaptic neurons through gating GABA-activated Cl- channels. To date, however, the functional roles of GABA remain unclear in the autonomic nervous system. In the present study, we characterize GABA-activated Cl- currents in the neurons of major pelvic ganglia (MPG). METHODS: MPG neurons, located on the lateral surfaces of the prostate gland, from male rats were enzymatically dissociated. Ionic currents were recorded using whole-cell variant patch-clamp technique. Membrane potential was recorded under current clamp mode. Current traces were filterd at 2kHz by using 4-pole Bassel filter in the amplifier. RESULTS: Application of GABA (100micrometer) induced inward currents in the neurons, with holding potentials being maintained below the Cl- equilibrium potential (ECl). The GABA response was concentration-dependent and its reversal potential was close to the theoretical ECl. The GABA-induced Cl- currents were largely blocked by bicuculline (10micrometer, n=5), a GABAA receptor antagonist, but were not affected by 9-AC and niflumic acid, chloride channel blockers. GABA also produced significant membrane depolarization (19mV, n=28). As in the case of the Cl- currents, the GABA-induced depolarizations were largely blocked by bicuculline(10micrometer, n=6), but not by DIDS(50micrometer, n=4), another chloride channel blocker. CONCLUSION: The data suggest that GABAergic roles may be due to it's activation of excitatory GABAA receptors, which are expressed in MPG neurons.

Development of Voice Prescription Service System using Fingerprint Authentication / 대한의료정보학회지

Several years has passed to begin a new paradigm, job separation of a physician and a pharmaceutist, and a electronic prescription becomes common in large scale hospitals. However, the current prescription information system retains some problems such as insufficient patient usability, labor saving techniques and security. This paper is addressed to implement a voice prescription service system to solve the preceding problems. Several suggestions are presented to use voice recognition, voice compression, computer telephony and fingerprint authentication technology for the problems. Lab experimental results show that the processing time to identify drug items is reduced by 80% compared with conventional mouse usage and voice recording is more effective to direct drug usage in a complicated prescriptions. Online fingerprint authentication furnishes evidence of a patient permission and a physician prescription. This feature provides safer security than the current security system.

The Study of 46 Cases of Tsutsugamushi Disease in Young-Dong Region in Gang-Won-Do / 감염과화학요법

BACKGROUND: Although the incidence of tsutsugamushi disease has been increasing in Korea, epidemiological and clinical characteristics of tsutsugamushi disease in Young?dong province have not been reported. METHODS: We retrospectively reviewed the medical records of 46 patients of tsutsugamushi disease who admitted at Gangneung Asan hospital from 1997 to 2001. RESULTS: Incidence of tsutsugamushi disease in Young-dong province had been increasing since 1999. Most patients were infected during agricultural work. The incidence of women was higher than that of men (65.2%). Characteristic laboratory finding was elevation of AST and ALT, hypoalbuminemia and thrombocytopenia. Despite fever, leukocytosis was found only in 20% of patients. Course of disease was relatively good in most patients, but complications such as pneumonia, acute renal failure, and shock developed in 26% of patients. In one case with acute renal failure and another case with pneumonia, the patients' condition aggravated in spite of doxycycline therapy, thus, hemodialysis and mechanical ventilator care were done respectively. Consequently, both patients recovered completely without chronic complication. Old age (>65 years), longer duration from onset of symptoms to admission (>10 days), hypoalbuminemia at admission(<2.6 g/dL) and leukocytosis could be used as a marker for prediction of complications. CONCLUSION: Incidence of tsutsugamushi disease increased in Young?dong region. Old age, delayed admission, hypoalbuminemia and leukocytosis could be used as marker for prediction of complications.

The Study of 46 Cases of Tsutsugamushi Disease in Young-Dong Region in Gang-Won-Do / 감염과화학요법

BACKGROUND: Although the incidence of tsutsugamushi disease has been increasing in Korea, epidemiological and clinical characteristics of tsutsugamushi disease in Young?dong province have not been reported. METHODS: We retrospectively reviewed the medical records of 46 patients of tsutsugamushi disease who admitted at Gangneung Asan hospital from 1997 to 2001. RESULTS: Incidence of tsutsugamushi disease in Young-dong province had been increasing since 1999. Most patients were infected during agricultural work. The incidence of women was higher than that of men (65.2%). Characteristic laboratory finding was elevation of AST and ALT, hypoalbuminemia and thrombocytopenia. Despite fever, leukocytosis was found only in 20% of patients. Course of disease was relatively good in most patients, but complications such as pneumonia, acute renal failure, and shock developed in 26% of patients. In one case with acute renal failure and another case with pneumonia, the patients' condition aggravated in spite of doxycycline therapy, thus, hemodialysis and mechanical ventilator care were done respectively. Consequently, both patients recovered completely without chronic complication. Old age (>65 years), longer duration from onset of symptoms to admission (>10 days), hypoalbuminemia at admission(<2.6 g/dL) and leukocytosis could be used as a marker for prediction of complications. CONCLUSION: Incidence of tsutsugamushi disease increased in Young?dong region. Old age, delayed admission, hypoalbuminemia and leukocytosis could be used as marker for prediction of complications.

Acute Gastric Volvulus due to Diaphragmatic Hernia / 대한소화기학회지

Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. It designates abnormal rotation of the stomach along its longitudinal (organoaxial) or transverse (mesenteroaxial) axis. When the rotation exceeds 180 degrees, gastric obstruction or strangulation may occur. The classical presentation of acute gastric volvulus is the triad of severe epigastric pain, vomiting followed by retching without the ability to vomit, and difficulty or inability to pass a nasogastric tube. Delay in diagnosis and treatment of gastric volvulus can lead to fatal complications such as gastric ischemia, perforation, and hemorrhage. Gastric volvulus is a true emergency which should be treated immediately either surgically or by upper endoscopy. We report a case of an acute incarcerated gastric volvulus due to a left-sided diaphragmatic hernia in an adult male patient, which was treated successfully by operation.

Clinical Features of Simple Bronchial Anthracofibrosis which is not Associated with Tuberculosis / 결핵

BACKGROUND: Bronchial anthracofibrosis (BAF) is a dark black or brown pigmentation of multiple large bronchi associated with a fibrotic stenosis or obliteration that is incidentally found during a diagnostic bronchoscopy. Some reporters have suggested endobronchial tuberculosis or tuberculous lymphadenitis as a possible cause of BAF. However, some BAF patients do not have any medical history of tuberculosis. The aim of this study was to elucidate the clinical features of simple BAF patients, which were not associated with tuberculosis. METHODS: We reviewed the patients' charts retrospectively and interviewed all BAF patients who were followed up for 1 year or more. Among the 114 BAF patients, 43 patents (38 %) had no associated tuberculosis, cancer and pneumoconiosis. The clinical characteristics, radiological findings and associated pulmonary diseases of these patients were evaluated. RESULTS: Most patients were non-smokers, old aged, housewifes who resided in a farming village. The common respiratory symptoms were dyspnea, cough and hemoptysis. The predominant X-ray findings were a multiple bronchial wall thickening(89%), bronchial narrowing or atelectasis (76%) and a mediastinal lymph node enlargement with/without calcification (78%). Pulmonary function test usually showed mild obstructive ventilatory abnormalities but no patient showed a restrictive ventilatory pattern and the patients were frequently affected with chronic bronchitis(51%), post-obstructive pneumonia(40%) and chronic asthma(4%). CONCLUSION: Because BAF is frequently associated with chronic bronchitis and obstructive pneumonia as well as tuberculosis, a careful clinical evaluation and accurate differential diagnosis is more essential than empirical anti-tuberculous medication.

Antibiotic cement-coated Unreamed nailing for Treatment of Infected Nonunion of Long bone / 대한정형외과학회잡지

PURPOSE: Our study was aim to evaluate the results of treatment by antibiotic cement-coated unreamed nailing for infected nonunion of long bone shaft. MATERIALS AND METHODS: Ten cases of nonunion, 6 femurs and 4 tibias were included in this study. Average age of patients was 38.5 and men were eight. Average follow-up period was 16.4 months (12-35) . Etiologies of infection were open fractures (6 cases) and iatrogenic (4 cases) . Eight cases which had positive antimicrobial sensitivity test preoperatively were used a sensitive, heatstable, and powderform antibiotics. Primary autogenous bone grafting with nailing was perfomed in five cases. Delayed bone grafting after curettage and nailing was done in another five cases in infected by S. aures organism. RESULTS: All of ten cases had bony union. Union time was average 31.5 in femur and 26.4 in tibia. Early weight bearing ambulation and motion of adjacent joint were beneficial. But average 8 mm of shortening was developed and angulation more than 5 degrees occured in one case. CONCLUSION: Antibiotic cement coated-unreamed intramedullay nailing is the recommended treatment of method in infected nonunion of long bone shaft with minimal shortening.

Efficacy of Pain Mapping in Patients with Endometriosis Using Microlaparoscopy / 대한산부인과학회잡지

No abstract available.