Trichostatin A Protects Liver against Septic Injury through Inhibiting Toll-Like Receptor Signaling

Sepsis, a serious clinical problem, is characterized by a systemic inflammatory response to infection and leads to organ failure. Toll-like receptor (TLR) signaling is intimately implicated in hyper-inflammatory responses and tissue injury during sepsis. Histone deacetylase (HDAC) inhibitors have been reported to exhibit anti-inflammatory properties. The aim of this study was to investigate the hepatoprotective mechanisms of trichostatin A (TSA), a HDAC inhibitor, associated with TLR signaling pathway during sepsis. The anti-inflammatory properties of TSA were assayed in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Polymicrobial sepsis was induced in mice by cecal ligation and puncture (CLP), a clinically relevant model of sepsis. The mice were intraperitoneally received TSA (1, 2 or 5 mg/kg) 30 min before CLP. The serum and liver samples were collected 6 and 24-h after CLP. TSA inhibited the increased production of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in LPS-stimulated RAW264.7 cells. TSA improved sepsis-induced mortality, attenuated liver injury and decreased serum TNF-α and IL-6 levels. CLP increased the levels of TLR4, TLR2 and myeloid differentiation primary response protein 88 (MyD88) protein expression and association of MyD88 with TLR4 and TLR2, which were attenuated by TSA. CLP increased nuclear translocation of nuclear factor kappa B and decreased cytosolic inhibitor of kappa B (IκB) protein expression, which were attenuated by TSA. Moreover, CLP decreased acetylation of IκB kinase (IKK) and increased association of IKK with IκB and TSA attenuated these alterations. Our findings suggest that TSA attenuates liver injury by inhibiting TLR-mediated inflammatory response during sepsis.

Ethical Attitudes according to Education and Clinical Experience of Do-Not-Resuscitate (DNR) / 한국호스피스완화의료학회지

PURPOSE: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. METHODS: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. RESULTS: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. CONCLUSION: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.

Usefulness of CT and ERCP in Traumatic Pancreatic Injury

PURPOSE: To evaluate the usefulness of CT and ERCP in the diagnosis of traumatic pancreatic injury, and the degree of such injury. MATERIALS AND METHODS: Using CT (n=30) and ERCP (n=8), we retrospectively analyzed 30 cases of surgically proven traumatic pancreatic injury. Both CT and surgical findings were evaluated according to intra-and extra- pancreatic change and assigned to one of five grades, according to their pattern. ERCP findings were categorized as normal mass effect, parenchymal staining, or extravasation of contrast material. In all 30 cases CT and ERCP findings were compared with surgical findings. RESULTS: Pancreatic enlargement was the most common finding of intrapancreatic change in 21(67%) cases (67%). In 20 of 30 cases, there was good correlation between the CT grade and surgical grading. Of the remaining ten cases, seven cases (23%) were underestimated and three(10%) were overestimated. CT grade III or IV suggest pancreatic duct injury ; in two of 13 cases with this grade, such injury was not seen on surgery, however. Of the eight cases in which ERCP was performed, two were normal, one showed mass effect, one showed parenchymal staining, and four, all of which showed pancreatic duct injury on surgery, showed extravasation of contrast material. Two of these four cases were CT grade II, but on surgery, proven duct injury was seen. CONCLUSION: In cases of pancreatic duct injury, ERCP is superior to CT; where such injury is suspected, it should therefore be used to determine whether or not the injury is in fact present.

Species-Specific Detection of Listeria monocytogenes by Polymerase Chain Reaction

Three Listeria monocytogenes strains isolated from clinical cerebrospinal fluid samples. A PCR was performed by using oligonuclotide primers derived from the invasion-associated protein(iap) related gene sequence. As a result of PCR, we obtained 287-bp DNA fragment of specific product to L. monocytogenes species. The chromsomal DNA of genera Listeria species were subjected to southern blot hybridization with HRP-labeled 287-bp DNA probe to produce a L. monocytogenes banding pattern. In the cases of 10-fold dilution of L. monocytogenes cells, 8 x 10(2) cells/ml were detected by PCR.

Analysis of MRI in Chronic Alcoholics with Brain Atrophy

PURPOSE: To quantitatively evaluate by MRI brain atrophy and abnormal parenchymal signal intensity onT2-weighted spin echo image in alcoholics. MATERIALS AND METHODS: MRI of 24 alcoholic patients were retrospectively evaluated to measure brain atrophy (cerebral sulcal width, bifrontal horn distance, third ventricular width, fourth ventricular width, ambient cistern width, cerebellopontine angle cistern width, number of cerebellar sulci, and number of vermian sulci) and abnormal high signal lesions of brain parenchyma onT2-weighted spin echo image, and were compared with age matched controls (n=29). The alcoholics and controls were divided into two age groups, younger (30 - 49 years) and older (50 - 72 years), and statistical analysis was then performed. Axial and sagittal T1- and T2-weighted spin echo images were obtained using a 0.5 Tesla superconductive system. RESULTS: Statistical significant parameters in the supratentorial region were cerebral sulcal width, distance between lateral ends of frontal horns of both lateral ventricles, and third ventricular width (p<0.05),and in the infratentorial region were fourth ventricular width, ambient cistern width, cerebellopontine angle cistern width, number of cerebellar sulci, and number of vermian sulci (p<0.05). In the younger age group, statistical significant parameters were cerebral sulcal width, third ventricular width, ambient cistern width, cerebellopontine angle cistern width, number of cerebellar sulci, and number of vermian sulci (p<0.05) and in the older group were cerebral sulcal width, bifrontal horn distance, third ventricular width, fourth ventricular width, number of cerebellar sulci, and number of vermian sulci (p<0.05). Abnormal high signal intensity onT2-weighted spin echo images were seen in 46% of alcoholics (11/24) and in 13% of controls (3/29). High signal lesions in the older group were statistically significant (p<0.05). CONCLUSION: Atrophic brain changes and periventricular high signal foci on T2-weighted spin echo image are significantly higher in chronic alcoholics than in age-matched normal controls.

Comparative Analysis Among X-ray Mammographic Findings, Nuclear and Histologic Grading, and TNM Staging of Breast Carcinoma

PURPOSE: The purpose of this study was to evaluate the prognosis of breast carcinoma by comparison with X-ray mammographic findings, nuclear and histologic grade, and TNM staging. MATERIALS AND METHODS: We retrospectively reviewed 114 cases(113 patients) of breast carcinoma, analysing X-ray mammographic findings of all cases with regard to mass, calcification, and spiculation. In 80 cases of scirrhous invasive ductal breast carcinoma, Black's nuclear and Bloom-Richardson's histologic grade were also evaluated. Mammographic findings and nuclear and histologic grade were compared with TNM staging which might suggest the prognosis of breast carcinoma. RESULTS: X-ray mammographic findings (mass, calcification and spiculation) did not significantly correlate with T staging, but the clinical staging of the spiculation was advanced. These X-ray findings did not significantly correlate with the nuclear grading and the histologic grading. Nuclear grade did not correlate with T and M staging, but correlated significantly with N staging and clinical stage(p<0.05). Histologic grade did not significantly correlate with TNM staging. CONCLUSION: The clinical staging of spiculation was advanced and nuclear grade correlated significantly with N stage and clinical staging. X-ray mammographic findings did not directly correlate with nuclear and histologic grading, but combined studies of the evaluation of mammographic findings and nuclear and histologic grade were useful for prognosing breast carcinoma.

Analysis of X-ray Mammographic Findings of Breast Carcinoma according to Histopathologic Classification

PURPOSE: This study was undertaken to investigate X-ray mammographic findings which correlated with histopathologic classification of breast carcinomas. MATERIALS AND METHODS: In 114 cases (113 patients) weeviewed X-ray mammographic findings of breast carcinoma and their histopathologic classification, and the findings were analysed to define mass, calcification, and spiculation. RESULTS: According to histopathologic classifications of breast carcinomas, infiltrating ductal carcinoma was the most common(78.9%). X-rays mammographyrevealed that irregular mass was found in 43.9% of cases, calcification in 47.4 %, and radiating spiculation in75.4%. Mass with spiculation accounted for 41.2%, and mass with calcification and spiculation for 34.2%. A commonfinding of ductal carcinoma in situ was an ill-defined mass with malignant clustered microcalcification. Infiltrating ductal and infiltrating lobular carcinomas showed irregular masses with spiculation and colloid or medullary carcinomas had well-defined masses. CONCLUSION: Mass with spiculation, and mass with calcification and spiculation were common findings of breast carcinoma. The differences in X-ray mammographic findings among each different histopathologic type of breast carcinoma are helpful for differential diagnosis.

MR Findings of Laryneal Cancer: Pathologic Correlation

PURPOSE: MRI is known to display the anatomy of the larynx in excellent detail with its remarkable soft tissue delineation and multiplanar imaging capability. We evaluate the accuracy of MRI in diagnosis and staging of laryngeal cancer MATERIALS AND METHODS: Sixteen cases with pathologically proved squamous cell carcinoma of the larynx were reviewed, retrospectively. The examination was performed with a 0.5 T superconductive MR system and C1 surface coil. Axial, sagittal and coronal plane with T1WI(TR/TE 450/20) and T2WI(TR/TE 18OO/80) were done. RESULTS: Eleven cases with glottic cancer(5 Tla, 3 Tlb, 1 T3 and 2 T4) and 5 cases with supraglottic cancer (1 T1, 1 T3 and 1 T4) were included. Cancer tissue showed intermediate signal intensity on TIWI and high signal intensity on T2Wl. Among 16 cases, 13 cases were correctly staged and 3 cases were overstaged due to edema caused by previous biopsy, partial volume averaging effect of abutted lesion, or surrounding inflammation. CONCLUSION: MRI is an useful modality for diagnosis of laryngeal cancer, especially in evaluation of paraglottic extention on coronal image and cartilage invasion.

Position and Width of Normal Adult Optic Chiasm as Measured in Coronal MRI

PURPOSE: Purpose :To evaluate the position and transverse dimension of the adult optic chiasm in normal Korean adult. MATERIALS AND METHODS: The authors analysed 3D coronal volume images (TR/TE= 30/13, flip angle= 30 degrees) of 136 normal adult subjects without known visual abnormality. All MRI examinations were performed using a 0.5T system. MRI was reviewed retrospectively to determine the position (horizontal and tilted) of the potic chiosm and the transverse dimension of the optic chiasm was measured. RESULTS: Seventy-five (55%) of 136 normal subjects had horizontal position, and sixty-one (45%) had tilted position. Thirty-eight (62%) of 61 with tilted position showed higher position on the right side, and twenty-three (38%) showed higher position on the side. The average transverse dimension(mean SD) was 15.2 +/- 0.7mm in men and 14.6 +/- 1.0mm in women. The difference of transverse dimension between men and women was statistically significant. CONCLUSION: Tilted position of the adult optic chiasm on coronal MRI was seen in approximately half of normal adults. The average of transverse dimension of normal optic chiasm was 15mm.

MR measurement of normal pituitary gland height on midsagittal section: age and sex differentiation

Measurement of the normal pituitary gland height was performed on magnetic resonance (MR) images of 144 subjects with no known or suspected pituitary or hypothalamic diseases. Midsagittal T1 weighted images (T1WI) were used for measurement, and mean vertical height according to age and sex group was obtained. In all age groups, the pituitary height was greater in females than in meles, The group of 0-9 years in both genders showed the minimum mean pituitary height, The maximum mean height was observed in the 10-19 years age group in both genders. The height gradually decreased with increasing age after age 20 years. There was no subject with a height more than 9.0 mm in females or 8.0 mm in males. In conclusion the measurement of the normal pituitary pland height using mid sagittal MR imaging can be used for the evaluation of the pituitary gland lesions.