Expression of vascular endothelial growth factor is a clinically useful predictor for aggressive basal cell carcinoma / 고신대학교의과대학학술지

OBJECTIVES: Basal cell carcinoma (BCC) tumors are locally invasive but rarely metastatic. However, aggressive metastatic variants are being increasingly reported in elderly people. Here we investigated the clinical utility of vascular endothelial growth factor (VEGF) as a predictive biomarker for aggressive BCC variants. METHODS: Thirty-five pathologically confirmed cases of BCC that underwent surgical removal in the Plastic Surgery Department between January 1, 2011 and December 31, 2012 were studied. VEGF expression was analyzed in formalin-fixed paraffin-embedded tumor tissue by immunohistochemical staining. Positive staining was defined as more than 10% of the tumor cells showing immunoreactivity. The associations of VEGF expression with various clinicopathologic parameters were analyzed. RESULTS: The face was the most prevalent site (28/35), with 15 cases from the nose, 6 cases from the eyelid, and 5 cases from the cheek. The patients were aged between 41 and 86 years, with a mean age of 69.26 ± 173.903 years. The mean BCC size was 1.34 ± 3.853 cm, with a range of 0.3 cm to 12.0 cm. The mean tumor invasion depth from the basement epidermal membrane was 0.17 ± 0.035 cm, with a range of 0.03 cm to 1.10 cm. A mean of 5.66 ± 20.938 intraoperative frozen section slides were examined. VEGF was not expressed in 14 of the 35 patients (40.0%), whereas 42.9% of the patients had low expression and 17.1% of the patients had high expression. VEGF expression was significantly associated with age (P = 0.022), size (P = 0.030), site (P = 0.013), tumor invasion depth (P = 0.019), and number of intraoperatively frozen sections (P = 0.003). CONCLUSIONS: These results suggest that VEGF expression as assessed by immunohistochemistry can predict aggressive or poor prognosis in BCC.

Anti-proliferative effects of ginsenosides extracted from mountain ginseng on lung cancer / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of three major ginsenosides from mountain ginseng as anticancer substance and explore the underlying mechanism involved in lung cancer.</p><p><b>METHODS</b>The inhibitory proliferation of lung cancer by major five ginsenosides (Rb1, Rb2, Rg1, Rc, and Re) was examined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. Calculated 50% inhibition (IC50) values of five ginsenosides were determined and compared each other. Apoptosis by the treatment of single ginsenoside was performed by fluorescence-assisted cytometric spectroscopy. The alterations of apoptosis-related proteins were evaluated by Western blot analysis.</p><p><b>RESULTS</b>The abundance of ginsenosides in butanol extract of mountain ginseng (BX-MG) was revealed in the order of Rb1, Rg1, Re, Rc and Rb2. Among them, Rb1 was the most effective to lung cancer cell, followed by Rb2 and Rg1 on the basis of relative IC50 values of IMR90 versus A549 cell. The alterations of apoptotic proteins were confirmed in lung cancer A549 cells according to the administration of Rb1, Rb2 and Rg1. The expression levels of caspase-3 and caspase-8 were increased upon the treatment of three ginsenosides, however, the levels of caspase-9 and anti-apoptotic protein Bax were not changed.</p><p><b>CONCLUSION</b>Major ginsenosides such as Rb1, Rb2 and Rg1 comprising BX-MG induced apoptosis in lung cancer cells via extrinsic apoptotic pathway rather than intrinsic mitochondrial pathway.</p>

TDAG51 deficiency promotes oxidative stress-induced apoptosis through the generation of reactive oxygen species in mouse embryonic fibroblasts

Apoptosis has an important role in maintaining tissue homeostasis in cellular stress responses such as inflammation, endoplasmic reticulum stress, and oxidative stress. T-cell death-associated gene 51 (TDAG51) is a member of the pleckstrin homology-like domain family and was first identified as a pro-apoptotic gene in T-cell receptor-mediated cell death. However, its pro-apoptotic function remains controversial. In this study, we investigated the role of TDAG51 in oxidative stress-induced apoptotic cell death in mouse embryonic fibroblasts (MEFs). TDAG51 expression was highly increased by oxidative stress responses. In response to oxidative stress, the production of intracellular reactive oxygen species was significantly enhanced in TDAG51-deficient MEFs, resulting in the activation of caspase-3. Thus, TDAG51 deficiency promotes apoptotic cell death in MEFs, and these results indicate that TDAG51 has a protective role in oxidative stress-induced cell death in MEFs.

Nutritional Treatment: New Strategy for Management of Chronic Pelvic Pain / 고신대학교의과대학학술지

Chronic pelvic pain is a common condition in women of reproductive age and can be described as chronic nociceptive, inflammatory and neuropathic pain characterized by spontaneous pain or a response to various stimuli. Oxidative stress is a component of the inflammatory reaction associated with pain processes. Iron and NF-kappaB are well-known inducers of oxidative stress, and reactive oxygen species (ROS) are associated with chronic pelvic pain and play an important role in the regulation of genes expressing immunoregulators, cytokines, and other molecules. Chronic pelvic pain treatment is often unsatisfactory and limited to symptom control. However, dietary treatment with antioxidants can improve the function of the immune system and overcome free radical damage. Therefore, dietary supplementation is suggested as a means to treat some chronic medical conditions that respond poorly to medication. In summary, dietary treatment with antioxidants could be considered for new strategy for treatment of chronic pelvic pain and may be better tolerated by patients than current treatments.

Two Cases of Increased Parasympathetic Nerve System in Irritable Bowel Syndrome with Diarrhea as a Predominant Symptom / 고신대학교의과대학학술지

The irritable bowel syndrome(IBS) is a chronic functional gastrointestinal disorder, characterized by abdominal pain, bloating and bowel disturbance. The pathophysiology of IBS is very complicated. Recent studies indicate that the most important mechanisms include visceral hypersensitivity, abnormal gut motility, autonomic nervous system(ANS) dysfunction and disorder of regulation of the brain-gut axis. Patients with IBS frequently present impaired autonomic regulation. Heart rate variability(HRV) is an acknowledged tool for estimating autonomic function. We experienced two cases of increased parasympathetic nervous system by HRV in irritable bowel syndrome with diarrhea as a predominant symptom.

Postmortem Biochemistry (I) : Cardiac Markers / 대한법의학회지

In cases of atherosclerotic occlusion of coronary artery, is it appropriate to conclude that myocardial infarction is the true cause of death? More sensitive and specific diagnostic methods for the postmortem diagnosis of myocardial infarction are sometimes necessary because macroscopic or microscopic changes associated with early-phase acute myocardial injuries or myocardial infarct are sometimes absent in sudden cardiac death. Postmortem biochemical assessment of cardiac markers may help to evaluate the pathological cardiac status in sudden unexpected death without obvious cause. However, forensic pathologists are generally interested only in the macroscopic and microscopic findings for postmortem diagnosis of myocardial diseases and hesitate to use postmortem biochemical data because of the risk of postmortem changes. There are several clinically useful cardiac markers antemortem cardiac events such as myocardial injuries, infarct, or heart failure and postmortem data on cardiac markers in autopsy cases of sudden death have been reported. This review of postmortem data on cardiac markers in blood, other body fluids, and myocardial tissue will serve to introduce the recent international research trends and provide a foundation for a new field in postmortem biochemistry.

Relationship between Occupational Stress and Gastric Disease in Male Workers / 가정의학회지

BACKGROUND: Physical and mental health of workers is threatened due to various events and chronic occupational stress. This study was conducted to investigate the relationship between occupational stress and gastric disease in male workers of the shipbuilding industry. METHODS: Occupational stress measured among a total of 498 workers of a shipbuilding firm who visited the hospital for health examination using the Korean Occupational Stress Scale (KOSS)-short form, and the relationship between sociodemographic factors, health-related behaviors, occupational stress, and gastric disease, and the distribution of occupational stress by sociodemographic factors in the gastric disease group was examined. RESULTS: There was no significant association between gastric disease and total occupational stress score and its seven sub-factors. The analysis showed that risk of gastric disease was significantly higher in the Q1 group in which the stress caused by occupational discomfort among seven sub-factors was lowest than that in the Q4 group (odds ratio, 2.819; 95% confidence interval, 1.151 to 6.908). Analysis only on the gastric disease group showed that the stress score of laborers was higher in the four sub-factors than that of office workers (P < 0.05). Analysis on educational background showed that the scores of the three sub-factors were lower in subjects who's highest level of education was high school (P < 0.01). CONCLUSION: This study suggests that it is necessary to improve the culture of Korean collectivism in the workplace and to manage the occupational stress in the low-educated and laborers. It is recommended for future studies to confirm the causal relationship between occupational stress and gastric disease by large scale studies using a KOSS which appropriately reflects workplace culture.

The Effectiveness of Medical Communication Skill of Medical Students, through an Emphasis on Role Play / 고신대학교의과대학학술지

OBJECTIVES: Medical doctors require outstanding communication skills when meeting with their patients. Thus medical student need to education and training about medical communication skill. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. METHODS: In the year 2010 and 2011, first-year medical students at The Kosin University College of Medicine took 'Communication skills' course in total, 154 first-year medical students survey results was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet'. The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. RESULTS: All categories of communication skills showed an improvement. For year 2010, a statistically significant difference was shown into the 22 questions, whereas in 2011, improvements were shown in all questions. CONCLUSIONS: From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.

Prevention of Osteoporosis in Women / 대한폐경학회지

Osteoporosis, the most common bone disease, is a silent condition resulting in increased fracture risk. The disorder is characterized by compromised bone strength and increased susceptibility to fractures that have important health and socioeconomic consequences. The prevention of osteoporosis should begin early and continue throughout life with measures that maintain or improve bone health. These measures include regular physical activity and a balanced diet, including adequate intake of calcium and other minerals, proteins, and foods rich in antioxidants. In older persons at increased risk of fragility fractures, the prevention of falls and the maintenance of adequate vitamin D status are essential. Assessment of fracture risk, followed by proven effective non-pharmacologic and pharmacologic management remains low, even in patients who have sustained a fragility fracture. Non-pharmacologic intervention should always be implemented, but many patients also need pharmacologic intervention to achieve adequate fracture protection. While low bone mineral density (BMD) is a factor in bone fragility, low BMD is not the only factor. Drugs for osteoporosis should not only promote changes in BMD, but should be proven to reduce the incidence of fractures. This article reviews advances in strategies to prevent osteoporosis.

Prevention of Osteoporosis in Women / 대한폐경학회지

Osteoporosis, the most common bone disease, is a silent condition resulting in increased fracture risk. The disorder is characterized by compromised bone strength and increased susceptibility to fractures that have important health and socioeconomic consequences. The prevention of osteoporosis should begin early and continue throughout life with measures that maintain or improve bone health. These measures include regular physical activity and a balanced diet, including adequate intake of calcium and other minerals, proteins, and foods rich in antioxidants. In older persons at increased risk of fragility fractures, the prevention of falls and the maintenance of adequate vitamin D status are essential. Assessment of fracture risk, followed by proven effective non-pharmacologic and pharmacologic management remains low, even in patients who have sustained a fragility fracture. Non-pharmacologic intervention should always be implemented, but many patients also need pharmacologic intervention to achieve adequate fracture protection. While low bone mineral density (BMD) is a factor in bone fragility, low BMD is not the only factor. Drugs for osteoporosis should not only promote changes in BMD, but should be proven to reduce the incidence of fractures. This article reviews advances in strategies to prevent osteoporosis.

The Functional Food Usage and Relation with Fatigue for Male Workers / 가정의학회지

BACKGROUND: Fatigue is a common problem in male workers as they have responsibilities in both role in home and in work place. The use of functional food has been one of the popular choices for fatigue recovery. This study was conducted to investigate the prevalence of functional food usage and its relationship with fatigue in male workers. METHODS: The study subjects were male workers seen for health check up at a university hospital in Busan from May to July 2009. They completed a questionnaire including social factor, occupational factor, life style, functional food usage and disease status. The subjects were divided into groups according to fatigue severity. RESULTS: Among 770 subjects, 267 (34.7%) consumed functional food daily. Most of them used functional food to recover fatigue as a supplement nutrition by their wife's or surrounding person's recommendation. There were significant difference between fatigue and non-fatigue group in age, occupation satisfaction, alcohol drinking, and insomnia. The prevalence of fatigue was 37.8%. The functional food usage significantly increased with fatigue severity scale (P < 0.001). CONCLUSION: Fatigue is common problem in male workers. The functional food usage is relation with fatigue severity.

Decreased Bone Mineral density of Spine in Patients with Invasive Cervical Cancer / 대한골다공증학회지

OBJECTIVES: To investigate the spinal bone mineral density (BMD) in patients with invasive cervical cancer without bone metastases. METHODS: We measured spinal bone mineral densities by dual-photon absorptiometry in 119 patients with invasive uterine cervical cancer and compared them with measurements from 135 control women. RESULTS: When adjusted for age, mean bone mineral density in patients with uterine cervical cancer was 13.9% lower (P=0.0003) and age-matched percentiles were 9.2% lower (P=0.0003) than in control women. The deficits in bone mineral density and age-matched percentiles were confined to the uterine cervical cancer patients in their fifties. CONCLUSIONS: Our study results suggest that patients with invasive cervical cancer have a lower spinal BMD, resulting in an increased risk of osteoporosis.

To Investigate the Incidence of Non-responder to Hormone Therapy and the Bone Response in Postmenopausal Women / 대한골다공증학회지

OBJECTIVES: To investigate the incidence of non-responder to hormone therapy (HT) and to evaluate the bone response to HT according to basal bone mineral density(BMD) in postmenopausal women. METHODS: A total of 167 postmenopausal women received either continuous combined estrogenprogestogen replacement (n=102) or estrogen replacement (n=65) for 1 years. BMD at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry (DXA) before and 1 year after HT. RESULTS: The incidence of non-responder (women with >3% bone loss per year) to HT was 8.3% in the lumbar spine, and 22.1% in femoral neck. non-responder group had a higher basal BMD at the lumbar spine than responder group, and showed bone loss rate of 7.7% per year. After 1 year of HT, postmenopausal women with osteoporosis showed a higher rate of increase in BMD at the lumbar spine and femoral neck than women with normal BMD or osteopenia. CONCLUSIONS: The non-responders to HT have a higher basal lumbar BMD, compared with responders. The higher basal BMD at the lumbar spine is, the less bone conservation effect of HT is.

The Study of Bisphosphonate and Postmenopausal Hormone Treatment in Low Bone Mineral Density / 대한골다공증학회지

OBJECTIVES: To evaluate the effect of postmenopausal hormone therapy alone or in combination with bisphosphonate on bone mineral density (BMD) in postmenopausal women. METHODS: One hundred three women diagnosed with low BMD in postmenopausal women were included in this study. All patients were classified into two groups; oarl hormone therpy alone (Group I) or with alendronate (Group II), given for 12 months. Dual energy X-ray absorptiometry was used to measure BMD before and after 12 months of treatment. RESULTS: In all groups, significant increase in bone density measurements were seen at 12 months of treatment. The BMD of lumbar spine more increased significantly in Group II than Group I. CONCLUSIONS: Postmenopausal hormone therapy is effective in osteopenic and osteoporotic women. However, the combined treatment with hormone therapy and bisphophonate is more effective in postmenopausal women with low BMD.

A Case of Severe Brain Atrophy Found in the Man in His Twenties Who Drinks Moderate Amount of Alcohol / 가정의학회지

Brain atrophy is caused by the neuronal loss and reduction in Betz cell numbers. Among the many causes of brain atrophy, alcohol related atrophy is largely accounted for by a reduction in white matter volume. And the degree of brain atrophy correlates with the rate and amount of alcohol consumed over a lifetime, and it is at least partially reversible with alcohol abstinence. Alcohol-related brain damage mechanism correlates with that ethanol selectively and potently inhibits the function of NMDA receptors. Chronic alcoholics often have a low intake of folate, hence a sustained hyperhomocystenemia can frequently be observed, then this cause a pathological increase in receptor activity and subsequent excitotoxic damage. Even the consumption of light and moderate doses of alcohol lead to shrinkage of the brain and to increases in white matter volume and decrease in grey matter volume. We report the case of severe brain atrophy incidentally found at medical check-up in a young man who has drunken alcohol too much for 10 years.

The Effect of Vitamin C for Mercury Excretion by Hair Mercury Analysis / 가정의학회지

BACKGROUND: Humans are exposed to mercury via many different routes and in different forms. Studies concerned with the exposure in the general population were done many times in the past. But, the treatment of mercury exposure and mercury intoxication is limited. Therefore, chelators such as birth anti lewistite, 2,3-dimercaptopropanol (BAL), dimercaptopropane-1-sulphonate (DMPS), and dimercaptosuccinic acid (DMSA) were given to patients with acute symptoms resulting from the central nervous system due to confirmed mercury poisoning. In this paper, we reported the effects of oral Vitamin C on mercury excretion. METHODS: This study has been reviewed in the clinical findings of 213 patients aged 30-80 who visited Kosin University Gospel Hospital during 3 months from March to September 2007. We measured hair mercury levels at the initial visit and at 3-4 months after the oral vitamin C (4 g/day) treatment. RESULTS: The number of patients who had initial hair mercury level over 1.5 ppm were 57 patients among 213 patients, and 41 patients rechecked the hair mercury level. Twenty patients who had hair mercury level over 1.5 ppm were treated with oral vitamin C for 3 months and rechecked the hair mercury level and 21 patients without vitamin C treatment. The vitamin treatment group had a hair mercury level that was three times lower than the non-treated group. CONCLUSION: The vitamin C oral treatment significantly decreased the level of hair mercury.

Complaints of Fatigue and Dietary Life in Medical Students / 가정의학회지

BACKGROUND: Fatigue is a common problem in medical students and is thought to be related to poor academic performance. Fatigue is expected to be highly related to dietary habits, but previous research was not enough. Therefore, the aims of this study were to investigate the relationship between dietary habits and the prevalence of fatigue and also to give an update on basic research data for improving academic performance in medical students. METHODS: The study group consisted of 170 healthy second-year medical students attending three university school of medicine in Busan. They completed a questionnaire dealing with fatigue (Fatigue Severity Scale), dietary habits, lifestyle, and academic performance. RESULTS: On multivariate logistic regression analyses, skipping breakfast (completely skipping breakfast everyday versus having breakfast everyday; odds ratio 7.23; 95% confidence interval, 2.07 to 25.28; P = 0.002) was positively correlated with the complaints of fatigue. CONCLUSION: Skipping breakfast was associated with the complaints of fatigue in medical students.

Secretion of adenylate kinase 1 is required for extracellular ATP synthesis in C2C12 myotubes

Extracellular ATP (exATP) has been known to be a critical ligand regulating skeletal muscle differentiation and contractibility. ExATP synthesis was greatly increased with the high level of adenylate kinase 1 (AK1) and ATP synthase beta during C2C12 myogenesis. The exATP synthesis was abolished by the knock-down of AK1 but not by that of ATP synthase beta in C2C12 myotubes, suggesting that AK1 is required for exATP synthesis in myotubes. However, membrane-bound AK1beta was not involved in exATP synthesis because its expression level was decreased during myogenesis in spite of its localization in the lipid rafts that contain various kinds of receptors and mediate cell signal transduction, cell migration, and differentiation. Interestingly, cytoplasmic AK1 was secreted from C2C12 myotubes but not from C2C12 myoblasts. Taken together all these data, we can conclude that AK1 secretion is required for the exATP generation in myotubes.

Acute Painful Neuropathy (Insulin Neuritis) in a Woman Following Rapid Glycemic Control for Type I Diabetes Mellitus

We report a case of acute, painful polyneuropathy in a woman with newly diagnosed type I diabetes mellitus associated with a precipitous drop in hemoglobin A1c . She has had poorly controlled diabetes mellitus type I for 5 years despite diet, execise, oral therapy because she has been diagnosed type II diabetes mellitus 5 years before. She experienced diabetes ketoacidosis, and she presented with a hemoglobin A1c of 17.8% and was hospitalized for continuous subcutaneous insulin infusion. Following the initiation of continuous subcutaneous insulin infusion, the patient's hemoglobin A1c fell to 6.1% within 2 months. During this 2-month period, she developed severe burning in her hand, feet and trunk, accompanied by tingling paresthesia and dysesthesia. Nerve conduction studies were consistent with mild sensorymotor peripheral neuropathy. Initially, she required opiate analgesics for pain control because gabapetin or tramadol/acetminophen did not help. Three months after presentation, the patient showed dramatic improvement and her pain resolved. Although not well described in the neurologic literature, this case represents insulin neuritis, one of the few diabetic neuropathies that has a favorable outcome.

The Effect of Dialysis Membrane Flux on Amino Acid Loss in Hemodialysis Patients

We examined whether high flux membranes (HF) may induce a greater loss of amino acids compared to low flux membranes (LF). Ten hemodialysis patients participated in this study. Pre- and post-hemodialysis plasma amino acid profiles were measured by reverse-phase high pressure liquid chromatography for both HF and LF. We measured the dialysate amino acid losses during hemodialysis. The reduction difference for plasma total amino acid (TAA), essential amino acid (EAA), and branch chained amino acid (BCAA) was not significantly different in comparisons between the two membranes. (HF vs. LF; TAA 66.85+/-30.56 vs. 53.78+/-41.28, p=0.12; EAA 14.79+/-17.16 vs. 17.97+/-28.69, p=0.12; BCAA 2.21+/-6.08 vs. 4.16+/-10.98 mg/L, p=0.13). For the HF, the reduction in plasma amino acid levels for TAA and EAA were statistically significant. Although it was not statistically significant, the dialysate losses of BCAA were greater than the reduction in plasma (plasma reduction vs. dialysate loss; HF 2.21+/-6.08 vs. 6.58+/-4.32, LF 4.16+/-10.98 vs. 7.96+/-3.25 mg/L). HF with large pores and a sieving coefficient do not influence dialysate amino acid losses. Hemodialysis itself may influence the dialysate amino acid losses and may have an effect on protein metabolism.