Antidepressant-like Effects of p-Coumaric Acid on LPS-induced Depressive and Inflammatory Changes in Rats

Depression causes mental and physical changes which affect quality of life. It is estimated to become the second most prevalent disease, but despite its commonness, the pathophysiology of depression remains unclear and medicine is not sufficiently protective. p-Coumaric acid (p-CA) is a dietary phenolic acid which has been proven to have antifungal, anti-HIV, anti-melanogenic, antioxidant and anti-inflammatory effects. Considering these effects, we investigated whether p-CA can prevent depressive symptoms by reducing inflammatory cytokines in animals injected with lipopolysaccharide (LPS). Changes in despair-related behaviors, inflammatory cytokines, neurotrophic factors and synaptic activity were measured. In these animals, p-CA improved despair-related behavioral symptoms induced by LPS in the forced swim test (FST), tail suspension test (TST) and sucrose splash test (SST). p-CA also prevented the increase of inflammatory cytokines in the hippocampus such as cycloxigenase-2 and tumor necrosis factor-α due to LPS. Similarly, it prevented the reduction of brain-derived neurotrophic factor (BDNF) by LPS. Electrophysiologically, p-CA blocked the reduction of long-term depression in LPS-treated organotypic tissue slices. In conclusion, p-CA prevented LPS-induced depressive symptoms in animals, as determined by behavioral, biochemical and electrophysiological measures. These findings suggest the potential use of p-CA as a preventive and therapeutic medicine for depression.

Autogenous fresh demineralized tooth graft prepared at chairside for dental implant / 대한악안면성형재건외과학회지

BACKGROUND: This study aimed to evaluate the clinical usefulness of autogenous fresh demineralized tooth (auto-FDT) graft prepared at the chairside for alveolar bone grafting during dental implant surgery. METHODS: In total, 38 patients requiring both tooth extraction (for endodontic or periodontal reasons or third molar extraction) and alveolar bone regeneration for dental implant placement were included. Within 2 h after clean extraction, the teeth were prepared at the chairside to serve as bone graft material. In the same sitting, blocks or chips of this graft material were used to reconstruct defects at the osteotomy site simultaneously with or before implant placement. Twelve months after prosthesis fabrication and placement, the clinical findings and implant success rates were evaluated. Histological studies were randomly conducted for selected cases. RESULTS: Clinical evaluation showed favorable wound healing with minimal complications and good bone support for the implants. No implant was lost after 12 months of function following prosthetic rehabilitation. Histological examination revealed new bone formation induced by the graft material. CONCLUSIONS: Chairside preparation of autogenous fresh demineralized teeth after extraction can be a useful alternative to the use of autogenous bone or other graft materials for the immediate reconstruction of alveolar bone defects to facilitate subsequent implant placement.

A Case of Secondary Primary Malignancy after Lenalidomide Therapy for Multiple Myeloma / 대한내과학회지

Lenalidomide, an orally administered immune-modulating drug, has several mechanisms of action against multiple myeloma (MM). However, the mechanisms of action of immune-modulating drugs are not understood completely. Lenalidomide maintenance therapy prolongs the time to progression and increases the overall survival in patients with MM. However, secondary primary malignancy (SPM) has been noted as a serious adverse event in patients with MM treated with lenalidomide. Lenalidomide treatment is not covered by insurance. Consequently, physicians have little experience with the adverse events of lenalidomide treatment in patients with MM. Here, we describe a case of breast cancer after lenalidomide treatment for MM. To our knowledge, this is the first report of a lenalidomide-associated SPM in Korea. The risk factors associated with lenalidomide-associated SPM should be considered carefully when implementing chemotherapy regimens in patients with MM.

A Case of Condyloma Acuminata in a Virgin Systemic Lupus Erythematosus Patient

Anogenital infection with human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. The majority of HPV infections are transient and subclinical, with subsequent clearance by the immune system. However, in some individuals, especially those with impaired immunity, HPV infection may persist and result in condyloma acuminatum, pre-cancerous cervical abnormalities, as well as cervical cancer. Because of the intrinsic immunological aberrations and immunosuppressive treatment, patients with systemic lupus erythematosus (SLE) have higher prevalence of anogenital HPV infection, and SLE itself appears to be a major risk factor for HPV infection. HPV infection is sexually transmitted via genital contact; autogenesis of condyloma acuminatum without sexual contact is rare. In this case, a 27-year old virgin female with SLE was admitted to our clinic, presenting anogenital condyloma acuminata. It report that SLE patient can have a disease of anogenital HPV infection, despite the lack of sexual contact. Therefore, we recommend that patients with SLE have regular gynecological evaluations, in addition to prophylactic HPV vaccinations.

Acute Myocardial Infarction in a Patient with an Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Coronary Artery / 대한내과학회지

A 55-year-old male underwent coronary artery intervention for an acute myocardial infarction of the inferior or lateral wall. The initial left coronary angiogram showed total occlusion of the proximal left circumflex artery (LCX). There was an abnormal coronary artery originating from the mid-portion of the left anterior descending artery (LAD) and running to the right ventricular side. However, we could not identify the anomalous right coronary artery (RCA). We tried to find the RCA in the right coronary cusp to confirm the infarction-related artery, but failed. A focused left coronary angiogram in the posteroanterior projection revealed the entire anatomy of the anomalous RCA. An anomalous origin of the RCA from the LAD is a rare coronary artery anomaly that might affect the physician's decision during coronary intervention. We report an anomalous origin of the RCA from the mid-LAD and discuss the anatomy and clinical significance.

Resistive index as a predictor of acute kidney injury caused by an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker in chronic kidney disease patients

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) may induce acutekidney injury (AKI).The aim of this study was to evaluate the role of the resistive index (RI), which reflects renal artery resistance on renal duplex ultrasonography, as a predictor of AKI in chronic kidney disease (CKD) patients who are prescribed an ACE inhibitor or ARB. METHODS: We screened 105 CKD patients evaluated with renal duplex ultrasonography from 2008 to 2012. We excluded patients not treated with ACE inhibitor or ARB and diagnosed with renal artery stenosis. Finally, we retrospectively analyzed the medical records of 54 patients. AKI was defined as increased serum creatinine by >30% compared with baseline after starting ACE inhibitor or ARB treatment. RESULTS: The mean age of the patients was 60.5+/-13.0 years, serum creatinine level was 1.85+/-0.85 mg/dL and 22.2% of the patients had AKI after the use of an ACE inhibitor or ARB. The RI (P=0.006) and the percentages of patients with diabetes (P=0.008)and using diuretics (P=0.046) were higher in the AKI group.The area under the receiver operating characteristics curve for the prediction of AKI was 0.736 (95% confidence interval=0.587-0.885, P=0.013),and RI> or =0.80 predicted AKI with 83.3% sensitivity and 61.9% specificity. In the multivariate analysis, RI> or =0.80 was an independent prognostic factor [Exp (B)=8.03, 95% confidence interval=1.14-56.74, P=0.037] for AKI. CONCLUSION: RI> or =0.80 on the renal duplex ultrasonography may be a helpful predictor for AKI in CKD patients who are prescribed an ACE inhibitor or ARB.

Usefulness of the child health check list compared with the preoperative screening test

BACKGROUND: Recently, the value of routine preoperative screening tests has been questioned, especially in healthy children scheduled for elective minor surgery. We have assumed that sufficient history taking and physical examination could replace these tests. We prepared child health check lists for the parents to answer. Then, we compared the usefulness between preoperative screening tests and child health check lists. METHODS: Group A included 67 children, the parents of whom had answered the child health check list, and group B included 63 children who underwent routine preoperative screening tests. Each group was divided into ambulatory surgery patients (groups A1, B1) and patients admitted for surgery (group A2, B2). Comparison values between the two groups included preoperative evaluation time, operation time, anaesthesia time and recovery time. Also, clinical side effects were evaluated. RESULTS: The operation time, anaesthesia time and recovery time in each group showed no statistical differences. However, there were statistical differences of preoperative evaluation time. Preoperative evaluation time was significantly decreased in groups A1 (4.0 +/- 1.2), and A2 (5.4 +/- 1.3) compared to groups B1 (7.6 +/- 1.7), and B2 (8.6 +/- 1.8). CONCLUSIONS: The use of a child heath check list saved time in the preoperative evaluation and saved the effort of the anaesthesiologist. It also decreased the discomfort of the children by omitting the invasive procedure and it reduced the medical costs.

Emphysematous prostatitis combined with a liver abscess caused by Klebsiella pneumoniae

Emphysematous prostatitis is a rare condition that is characterized by gas and abscess accumulation in the prostate. This uncommon but serious disease requires special attention because of its nonspecific presentation such as dysuria, frequency, urgency, fever, acute urinary retension and/or perineal pain. We report here on a case of emphysematous prostatitis that was combined with a liver abscess caused by Klebsiella pneumoniae. A 55-year-old man was admitted due to a 3-day history of urinary retention with a febrile sensation. He had histories of liver cirrhosis and uncontrolled diabetes mellitus. After blood and urine cultures, levofloxacin 500 mg was started intravenously. On the third hospital day, he displayed septic shock. The kidneys-ureters bladder (KUB) X-ray showed pockets of air-accumulation in the lower pelvic cavity, and abdominopelvic computed tomography (CT) with contrast enhancement taken on the third day showed a 5-cm liver abscess with an emphysematous prostate. Intravenous antibiotics was changed to metronidazole 500 mg q.i.d. and cefotaxime 2 g t.i.d. On the sixth day, transurethral resection and drainage were performed under spinal anesthesia. However, the postoperative bleeding continued and hypovolemic shock persisted, which then provoked multiorgan failure. The patient died on the 11th hospital day. K. pneumoniae was cultured from the liver abscess aspirate, blood and prostatic tissue, and the bacteria were sensitive to both levofloxacin and cefotaxime. Emphysematous prostatitis is a difficult to diagnose because of its rarity and nonspecific symptoms. A delayed diagnosis can cause high mortality and morbidity, so making a prompt clinical diagnosis of this condition is essential. Appropriate antibiotics with early adequate incision and drainage are also needed.

Angiogenic factor-enriched platelet-rich plasma enhances in vivo bone formation around alloplastic graft material

PURPOSE: Although most researchers agree that platelet-rich plasma (PRP) is a good source of autogenous growth factors, its effect on bone regeneration is still controversial. The purpose of this study was to evaluate whether increasing angiogenic factors in the human PRP to enhance new bone formation through rapid angiogenesis. MATERIAL AND METHODS: In vitro, the human platelets were activated with application of shear stress, 20 microgram/ml collagen, 2 mM CaCl2 and 10U thrombin/1 x 109 platelets. Level of vascular endothelial growth factor (VEGF) and platelet microparticle (PMP) in the activated platelets were checked. In the animal study, human angiogenic factors-enriched PRP was tested in 28 athymic rat's cranial critical bone defects with beta-TCP. Angiogenesis and osteogenesis were evaluated by laser Doppler perfusion imaging, histology, dual energy X-ray densinometry, and micro-computed tomography. RESULTS: In vitro, this human angiogenic factors-enriched PRP resulted in better cellular proliferation and osteogenic differentiation. In vivo, increasing angiogenic potential of the PRP showed significantly higher blood perfusion around the defect and enhanced new bone formation around acellular bone graft material. CONCLUSION: Angiogenic factor-enriched PRP leads to faster and more extensive new bone formation in the critical size bone defect. The results implicate that rapid angiogenesis in the initial healing period by PRP could be supposed as a way to overcome short term effect of the rapid angiogenesis.

Ultrasound assisted parascalene brachial plexus block for performing arthroscopic shoulder surgery: report on 8 cases: A case report / 대한마취과학회지

Performing a brachial plexus block is very useful for shoulder arthroscopic surgery. Several techniques for blocking the brachial plexus have been described with the purpose of improving the efficacy and minimizing the risk. The parascalene approach was introduced in 1979. This block approaches at the lateral border of the anterior scalene muscle and superior to the clavicle. At this level, the incidences of phrenic nerve paralysis and spinal or epidural anesthesia should be minimized. Previous studies have reported on ultrasound-assisted brachial plexus blocks, but few studies have applied this imaging technology to the parascalene region. We report here on 8 cases of parascalene brachial plexus block with using ultrasound guidance to show the clinical usefulness of this technology for conducting arthroscopic shoulder surgery. Ultrasound technology is valuable to anesthesiologists to localize nerves and the needle placement during the parascalene approach to block the brachial plexus for conducting arthroscopic shoulder surgery.

Huge Peripheral Ossifying Fibroma of the Lower Posterior Edentulous Ridge: Case Report

What is the optimal effect-site concentration of remifentanil for minimizing the cardiovascular changes to endotracheal intubation during induction with propofol in elderly patients? / 대한마취과학회지

BACKGROUND: The addition of remifentanil during propofol TCI (target controlled infusion) attenuates the hemodynamic changes induced by endotracheal intubation. This study examined the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation in elderly patients. METHODS: Fifty ASA 1 or 2 elderly patients scheduled for elective surgery under general anesthesia were assigned randomly to one of two groups according to the effect-site concentration of remifentanil. Each group was administered 4 microgram/ml of propofol TCI with 1 ng/ml (group R1) or 3 ng/ml (group R3) of remifentanil. The heart rate (HR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP) were measured at pre-induction, before and after endotracheal intubation. RESULTS: After intubation, the HR, SAP, MAP and DAP increased significantly in the two groups compared with the pre-intubation values. However, the HR, SAP, MAP and DAP for group R3 were lower than group R1 for 5 min after intubation. CONCLUSIONS: In elderly patients administered 4 microg/ml of propofol TCI, we suggest that the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation is 3 ng/ml rather than 1 ng/ml.

Clinical characteristics of infective endocarditis caused by Staphylococcus aureus: A 12-year experience in a tertiary-care hospital / 대한내과학회지

BACKGROUND/AIMS: The risk factors and clinical outcome of infective endocarditis (IE) have changed over the past few decades. Recently, the incidence of Staphylococcus aureus IE (SAIE) has increased. We investigated the clinical and microbiological characteristics and clinical outcomes of SAIE. METHODS: All patient cases that were diagnosed as IE according to the modified Duke criteria in Samsung Medical Center during the period of January 1995 to December 2006 were reviewed retrospectively. The clinical and microbiological characteristics of patients with SAIE were compared to those of non-SAIE patients with IE. RESULTS: We enrolled 304 patients with IE. Of these, 240 cases were IE culture-positive, including 73 cases of SAIE. The mean age of patients with SAIE was 48.15+/-19.87 years, with male patients accounting for 71.2% of our study group. Congenital heart disease (8.2%) was less common among SAIE patients. Hospital-acquired IE was significantly more common in SAIE than in non-SAIE cohorts (p 0.05). Methicillin resistance and non-surgical treatment were significant risk factors for in-hospital mortality. CONCLUSIONS: SAIE is more strongly associated with systemic embolization, persistent fever, and longer hospital stays compared to non-SAIE. Further studies are warranted to evaluate adequate treatment and to improve the outcome of patients with SAIE.

The use of Pentax-AWS for a difficult airway due to post-thyroidectomy hematoma : A case report

Post-thyroidectomy hematoma is a rare complication, but this complication is potentially life threatening and unpredictable.This complication requires emergency tracheal intubation, which is often difficult because of swollen tissues, poor visualization of the glottis and the distorted airway anatomy.Using the direct laryngoscopy with a Macintosh laryngoscope, we were unable to see even the epiglottis.Pentax-AWS (Pentax-AWS(R), Pentax, Japan) is a new video laryngoscope that provides an indirect view of the glottis and it has a tube channel in the right side of the blade.We were able to fully view larynx with a Pentax-AWS, and then we intubated the trachea immediately and easily.The Pentax-AWS could be a useful alternative device that overcomes the above mentioned difficulties.

The use of Pentax-AWS for a difficult airway due to post-thyroidectomy hematoma : A case report

Post-thyroidectomy hematoma is a rare complication, but this complication is potentially life threatening and unpredictable.This complication requires emergency tracheal intubation, which is often difficult because of swollen tissues, poor visualization of the glottis and the distorted airway anatomy.Using the direct laryngoscopy with a Macintosh laryngoscope, we were unable to see even the epiglottis.Pentax-AWS (Pentax-AWS(R), Pentax, Japan) is a new video laryngoscope that provides an indirect view of the glottis and it has a tube channel in the right side of the blade.We were able to fully view larynx with a Pentax-AWS, and then we intubated the trachea immediately and easily.The Pentax-AWS could be a useful alternative device that overcomes the above mentioned difficulties.

Salivary Bacterial Counts after Application of Povidone-Iodine and Chlorhexidine

OBJECTIVE: It is important to sterilize oral cavity with antibacterial agent before surgery for preventing infection. The object of this study was to compare the effect on reduction of salivary bacterial counts according to applied time when povidone-iodine (PVI) and chlorhexidine gluconate (CHX), most broadly used materials in dentistry, were applied intraorally before the surgery. METHODS: Sixty subjects were divided into 6 groups. PVI and CHX were applied in each group for 1, 2 and 3 minutes, respectively. Then salivary microbacteria taken before and after applying the materials were cultured using 5% sheep blood agar plate. RESULTS: There was significant difference in reduction of microbacteria in both PVI and CHX and the effect did not show differences depending on time. When applied for a minute, PVI showed somewhat higher reduction rate than CHX, but in the other groups, there was no difference in reduction rate. CONCLUSION: We found that there was no significant difference in sterilization ability of PVI and CHX in all groups in this study. Therefore, both agents would get sufficient effect when applied for a minute.

Salivary Bacterial Counts after Application of Povidone-Iodine and Chlorhexidine

OBJECTIVE: It is important to sterilize oral cavity with antibacterial agent before surgery for preventing infection. The object of this study was to compare the effect on reduction of salivary bacterial counts according to applied time when povidone-iodine (PVI) and chlorhexidine gluconate (CHX), most broadly used materials in dentistry, were applied intraorally before the surgery. METHODS: Sixty subjects were divided into 6 groups. PVI and CHX were applied in each group for 1, 2 and 3 minutes, respectively. Then salivary microbacteria taken before and after applying the materials were cultured using 5% sheep blood agar plate. RESULTS: There was significant difference in reduction of microbacteria in both PVI and CHX and the effect did not show differences depending on time. When applied for a minute, PVI showed somewhat higher reduction rate than CHX, but in the other groups, there was no difference in reduction rate. CONCLUSION: We found that there was no significant difference in sterilization ability of PVI and CHX in all groups in this study. Therefore, both agents would get sufficient effect when applied for a minute.

A biologic study on toothash - plaster of paris mixture with absorbable collagen membrane in the treatment of peri-implant defects

Xenotransplant of human bone marrow stromal cells: effect on the regeneration of axotomized infraorbital nerve in rats

This study demonstrated that xenogenic human marrow mesenchymal stem cells (hMSCs) could elicit the regeneration of the sensory nerve after axotomy in the adult rats'infraorbital nerves without immunosuppression. For this, we evaluated the behavioral testing for functional recovery of the nerve and histological findings at weeks 3 and 5 compared to controls. Xenogenic hMSCs did not evoke any significant inflammatory or immunologic reaction after systemic and local administrations. HMSCs-treated rats exhibited significant improvement on sensory recovery tested with von Frey monofilaments. At 5 postoperative weeks, in the hMSCs treated nerve, expression of myelin basic protein (MBP), neurofilament (NF) at the site of axotomy was higher than control. And mRNA expression of neurotropin receptor Trk precursor (TrkPre), nerve growth factor receptor (NGFR) and neuropeptide (NPY) in trigeminal ganglion were also higher. The number of myelinated nerve at distal stump and cells in trigeminal ganglion were higher in hMSC treated rats. So it was supposed that transplanted MSCs contributed to reducing post-traumatic degeneration and production of neurotrophic factors. Immunofluorescence labeling showed small portion of hMSCs(<10%) expressed a phenotypic marker of Schwann cell (S-100). Xenogenic or allogenic mesenchymal stem cells might have immune privileged characteristics and useful tool for cell based nerve repair.

Reduction glossectomy of macroglossia in beckwith-wiedemann syndrome : a case report