Multilayered Cell Sheets of Cardiac Reprogrammed Cells for the Evaluation of Drug Cytotoxicity

BACKGROUND@#Various cell-culture systems have been used to evaluate drug toxicity in vitro. However, factors that affect cytotoxicity outcomes in drug toxicity evaluation systems remain elusive. In this study, we used multilayered sheets of cardiac-mimetic cells, which were reprogrammed from human fibroblasts, to investigate the effects of the layer number on drug cytotoxicity outcomes. @*METHODS@#Cell sheets of cardiac-mimetic cells were fabricated by reprogramming of human fibroblasts into cardiacmimetic cells via coculture with cardiac cells and electric stimulation, as previously described. Double-layered cell sheets were prepared by stacking the cell sheets. The mono- and double-layered cell sheets were treated with 5-fluorouracil (5-FU), an anticancer drug, in vitro. Subsequently, apoptosis and lipid peroxidation were analyzed. Furthermore, effects of cardiacmimetic cell density on cytotoxicity outcomes were evaluated by culturing cells in monolayer at various cell densities. @*RESULTS@#The double-layered cell sheets exhibited lower cytotoxicity in terms of apoptosis and lipid peroxidation than the mono-layered sheets at the same 5-FU dose. In addition, the double-layered cell sheets showed better preservation of mitochondrial function and plasma membrane integrity than the monolayer sheets. The lower cytotoxicity outcomes in the double-layered cell sheets may be due to the higher intercellular interactions, as the cytotoxicity of 5-FU decreased with cell density in monolayer cultures of cardiac-mimetic cells. @*CONCLUSION@#The layer number of cardiac-mimetic cell sheets affects drug cytotoxicity outcomes in drug toxicity tests.The in vitro. cellular configuration that more closely mimics the in vivo configuration in the evaluation systems seems to exhibit lower cytotoxicity in response to drug.

Multilayered Cell Sheets of Cardiac Reprogrammed Cells for the Evaluation of Drug Cytotoxicity

BACKGROUND@#Various cell-culture systems have been used to evaluate drug toxicity in vitro. However, factors that affect cytotoxicity outcomes in drug toxicity evaluation systems remain elusive. In this study, we used multilayered sheets of cardiac-mimetic cells, which were reprogrammed from human fibroblasts, to investigate the effects of the layer number on drug cytotoxicity outcomes. @*METHODS@#Cell sheets of cardiac-mimetic cells were fabricated by reprogramming of human fibroblasts into cardiacmimetic cells via coculture with cardiac cells and electric stimulation, as previously described. Double-layered cell sheets were prepared by stacking the cell sheets. The mono- and double-layered cell sheets were treated with 5-fluorouracil (5-FU), an anticancer drug, in vitro. Subsequently, apoptosis and lipid peroxidation were analyzed. Furthermore, effects of cardiacmimetic cell density on cytotoxicity outcomes were evaluated by culturing cells in monolayer at various cell densities. @*RESULTS@#The double-layered cell sheets exhibited lower cytotoxicity in terms of apoptosis and lipid peroxidation than the mono-layered sheets at the same 5-FU dose. In addition, the double-layered cell sheets showed better preservation of mitochondrial function and plasma membrane integrity than the monolayer sheets. The lower cytotoxicity outcomes in the double-layered cell sheets may be due to the higher intercellular interactions, as the cytotoxicity of 5-FU decreased with cell density in monolayer cultures of cardiac-mimetic cells. @*CONCLUSION@#The layer number of cardiac-mimetic cell sheets affects drug cytotoxicity outcomes in drug toxicity tests.The in vitro. cellular configuration that more closely mimics the in vivo configuration in the evaluation systems seems to exhibit lower cytotoxicity in response to drug.

Diagnostic Accuracy of Electrocardiogram-Gated Thoracic Computed Tomography Angiography without Heart Rate Control for Detection of Significant Coronary Artery Stenosis in Patients with Acute Ischemic Stroke: A Comparative Study

OBJECTIVE: To compare the diagnostic performance of electrocardiogram (ECG)-gated thoracic computed tomography angiography (TCTA) without heart rate (HR) control in ischemic stroke patients with coronary CTA (CCTA) in non-stroke patients for detection of significant coronary artery stenosis. MATERIALS AND METHODS: From September 2009 through August 2014, we retrospectively enrolled 138 consecutive patients diagnosed with acute ischemic stroke who had undergone ECG-gated TCTA and conventional coronary angiography (CCA). Over the same period, we selected 167 non-stroke patients with suspected or known coronary artery disease who had undergone CCTA and CCA. With CCA as the reference standard, the diagnostic performance of TCTA and CCTA for identification of significant coronary stenosis (diameter reduction ≥ 50%) was calculated. RESULTS: There was no significant difference in baseline characteristics between TCTA (n = 132) and CCTA (n = 164), except for the higher prevalence of atrial fibrillation in the stroke group. There was significant difference (p < 0.001) between TCTA and CCTA in average HR (68 ± 12 vs. 61 ± 10 beats per minute) and image quality score (1.3 ± 0.6 vs. 1.2 ± 0.6). Significant coronary stenosis was identified in 101 (77%) patients, 179 (45%) vessels, and 293 (15%) segments of stroke patients, and in 136 (83%) patients, 259 (53%) vessels, and 404 (16%) segments of non-stroke patients. Diagnostic performance on a per-vessel and per-patient basis was similar in both TCTA and CCTA groups. There was only significant difference in area under receiver-operating characteristic curve between TCTA and CCTA groups (0.79 vs. 0.87, p < 0.001) on per-segment basis. CONCLUSION: Electrocardiogram-gated TCTA without HR control facilitates the identification of significant coronary stenosis in patients with ischemic stroke.

The effect of intrathecal baclofen single injection on neuropathic pain

BACKGROUND: Baclofen is a gamma-aminobutyric acid B-receptor agonist, which is usually used for patients with spasticity or patients with nerve injury inducing both spasticity and neuropathic pain. Both oral administration and intrathecal injection via a continuous infusion pump are common treatment methods. The aim of this study was to evaluate the effectiveness of a series of three individual injections of intrathecal baclofen for neuropathic pain without spasticity. METHODS: Thirty-one patients with neuropathic pain were treated with a series of three monthly individual injections of intrathecal baclofen without pump implantation A dose of 50 µg of baclofen was used. 10-cm visual analog scale (VAS) scores of spontaneous pain, allodynia, and hyperalgesia were recorded a week after each injection. Vital signs were monitored to detect any hemodynamic changes, and a myelogram was performed to detect any undesirable cerebrospinal fluid leakage. All patients were hospitalized for at least one day following each injection for close observation and to control any adverse effects. RESULTS: VAS scores of spontaneous pain, allodynia, and hyperalgesia decreased significantly (P < 0.001). The major complications were general weakness, sleepiness, and urinary retention; most of these resolved within one day without any further serious symptoms. CONCLUSIONS: A series of three individual intrathecal baclofen injections was effective for those patients who suffered from neuropathic pain without spasticity or dystonia; no serious complications were observed. However, the average satisfaction score recorded for spontaneous pain was lower than those for allodynia and hyperalgesia.

Anesthetic experience using extracorporeal membrane oxygenation for cesarean section in the patient with peripartum cardiomyopathy: a case report / 대한마취과학회지

Peripartum cardiomyopathy is a rare form of cardiomyopathy that is associated with significant mortality. It can cause a cardiac arrest during cesarean section even though the patient does not have any previous symptom and sign. The most important thing of anesthesia in this patient is an optimization of hemodynamic and respiratory status. We report the successful general anesthesia using of extracorporeal membrane oxygenation for cesarean section in a 34-year-old woman with fulminant peripartum cardiomyopathy.

Factors Affecting Pneumonia Occurring to Patients with Multiple Rib Fractures

BACKGROUND: Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures. MATERIALS AND METHODS: Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded. RESULTS: There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22). CONCLUSION: The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.

Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients / 대한마취과학회지

BACKGROUND: Children and parents experience significant anxiety and distress during the preoperative period. This is important because preoperative anxiety in children is associated with adverse postoperative outcome. So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application, world-widely used. METHODS: A total 120 patients (aged 1-10 years old) who were scheduled for elective surgery under general anesthesia was included in this randomized controlled trial. We randomized the patients into three groups, with using intravenous (IV) midazolam sedation (M group), with using smartphone application program (S group), and with using low dose IV midazolam plus smartphone application program (SM group). And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) at holding area, 5 min after intervention, entrance to operating room. RESULTS: In all three groups, mYPAS after intervention were lower than the preoperative holding area (M group 52.8 +/- 11.8 vs 41.0 +/- 7.0, S group 59.2 +/- 17.6 vs 36.4 +/- 7.3, SM group 58.3 +/- 17.5 vs 26.0 +/- 3.4). A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group (P < 0.01), and the SM group exhibited significantly lower anxiety than the two other groups (P < 0.01). CONCLUSIONS: The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety.

Surgical Treatment of Acute Arterial Occlusion after Applying the Vascular Closure Device for Hemostasis of Femoral Arteriotomy in Vascular Intervention

Vascular intervention via the femoral artery can cause vascular access complications and complications from closure of the arteriotomic incision site such as bleeding, thrombotic complications and vascular trauma. These types of complications occur in about 2% to 10% of the cases. After removal of the catheter, hemostasis is traditionally achieved by manual compression as a standard method. Many vascular closure devices have been developed in an attempt to improve the patient's comfort and to decrease the time to ambulation. Yet the safety and effectiveness of these vascular closure devices as compared to that of manual compression remains unclear. Herein we report on a case of femoral arterial occlusion due to vascular closure devices and the operative management.

Educational Needs of Homemakers Regarding Emergency Situations in the Home: Focused on Differences in Educational Needs based on the General Characteristics of Homemakers and Differences between Homemakers and Emergency Physicians

PURPOSE: To investigate the educational needs and attitudes of homemakers regarding emergency situations in the home and to compare differences in perceptions about emergency situations according to the general characteristics of homemakers and differences between homemakers and emergency physicians METHODS: Using a written survey of a randomly selected sample, we questioned 69 emergency physicians and 450 homemakers over a 5 month period from November 2008 to March 2009. The survey consisted of 8 medical conditions and 16 injury-related conditions. It contained questions (using a Likert scale) about the need for education about each condition (the higher the score, the greater the need). We also determined homemakers' general characteristics: their age, educational background, number of children, gender of their children, age of their children, the existence of older families, and prior training in the process of resuscitation. RESULTS: A total of 346(77%) homemakers responded. For most conditions, the average scores were higher (greater need) among homemakers than among emergency physicians. There were significant differences between these two groups, especially for seizure, fever, dyspnea, bleeding, contusions (of the head, face, extremities, cervical spine and other areas), wounds (of the head, face, oral cavity and extremities), amputated tissue control, injury to teeth, burns, foreign body ingestion, intoxication, and electrical shock. According to the general characteristics of homemakers, the educational background affected the educational needs for homemakers for dyspnea, and for contusions of the head, face, and cervical spine. CONCLUSION: The need for education regarding emergency conditions in the home are higher in the eyes of homemakers than in the eyes of emergency physicians. General characteristics of homemakers affects educational needs. The subject of educational program about first aid will be chosen according to general characteristics of homemakers. according to general characteristics of homemakers.

Airway management in a patient with Treacher Collins syndrome: A case report / 대한마취과학회지

Treacher Collins Syndrome (TCS) is an autosomal dominant genetic disorder which is resulted from the mutation that affect the Treacher Collins-Franceschetti syndrome 1 (TCOF1) gene on chromosome 5. The features of patients affected by this syndrome are characterized by depression of the malar bones, an antimongoloid slant of the palpebral fissures, coloboma of the lower lids, mandibular hypoplasia with retrognathia and deformities of the ear structures. The airway obstruction is frequently caused by mandibular hypoplasia. This may necessitate the placement of a tracheostomy for airway patency after the birth. We experienced a tracheostomy for an infant with respiratory difficulty associated airway obstruction.

Malignant hyperthermia during general anesthesia for a surgery of idiopathic scoliosis: A case report / 대한마취과학회지

Malignant hyperthermia is a potentially fatal hypermetabolic syndrome characterized by skeletal muscle rigidity and hyperpyrexia. We had an 11-year-old female presented for a surgery for idiopathic scoliosis of the thoracic vertebra. Generalized muscle rigidity and tachycardia were revealed 1 hour 35 minutes after isoflurane administration. Then the body temperature was risen to 43degrees C within 10 minutes and the arterial blood gas analysis showed a severe respiratory and metabolic acidosis. Under the suspicion of malignant hyperthermia, the patient was treated by discontinuing all anesthetic agents, hyperventilation with 100% oxygen, surface cooling with ice pack and the administration of dantrolene sodium. But, the patient died of renal failure and disseminated intravascular coagulation after 50 days postoperatively.

Anesthesia for a 10-year-old boy with Duchenne muscular dystrophy syndrome: A case report / 대한마취과학회지

Duchenne muscular dystrophy (DMD) is an eventually fatal disorder that is characterized by rapidly progressive muscle weakness and atrophy of muscle tissue. The clinical manifestations of DMD vary depending on the stages of the disease. Succinylcholine-induced hyperkalemia and the administration of volatile anesthetic agents, - particularly halothane, - during acute rhabdomyolysis are more likely to result in cardiac arrest and unsuccessful resuscitation in DMD patients than in the general public. This is a case report of a 10-year-old boy who underwent elective strabismus revision under general anesthesia. Anesthesia was induced and maintained with intravenous propofol and remifentanil, which was started at the targeted effect concentration of 3.0micrometer/ml and 3.5 ng/ml respectively via target controlled infusion (TCI). No inhaled anesthetic was used. In addition, an initial dose 0.4 mg/kg of atracurium was injected intravenously over 15s. The results of this case report found intravenous infusion of propofol, remifentanil and atracurium to be safe because the malignant hyperthermia did not occur.

Nuclear Translocation of NF-kappaB/Rel Component by PCSC22 Isolated from Poria cocos Sclerotium / 대한해부학회지

The sclerotium of Poria cocos Wolf, which grows on the roots of pine trees, has long been used as a sedative and diuretic (Chang and But, 1987). The accumulating data revealed that certain ingredients of the sclerotium of Poria cocos showed anti-tumor activities (Kanayama, 1986). Although the mechanism of anti-tumor activity is not known, the polysaccharides may potentiate the host defense mechanism through the activation of immune system. In the present study we show that PCSC22, a polysaccharide isolated from the sclerotium of Poria cocos with one percent sodium carbonate, significantly induces nitric oxide (NO) production and inducible NO synthase (iNOS) transcription. To further investigate the mechanism responsible for the induction of iNOS gene expression, we investigated the effect of PCSC22 on the activation of NF-kappaB/Rel, whose binding site was located in the promoter of iNOS gene. Immuno-histo-chemical staining of p65 and p50 showed that PCSC22 produced strong induction of NF-kappaB/Rel nuclear translocation. Electrophoretic mobility shift assay (EMSA) further confirmed the activation of NF-kappaB/Rel by PCSC22. In conclusion, we demonstrate that PCSC22 stimulates macrophages to express iNOS gene through the activation of NF-kappa B/Rel.

A Case of Diffuse Leukoencephalopathy Following Low Dose Intravenous Methotrexate Therapy

Diffuse leukoencephalopathy is a well-known complication of methotrexate in intrathecal or high dose intravenous administration, especially when it is combined with cranial radiation therapy. However, low dose intravenous methotrexate induced leukoencephalopathy has not been reported previously. A 46-year-old female was administered intravenous methotrexate and 5-fluorouracil with oral cyclophosphamide after a modified radical mastectomy for breast cancer. After six cycles of chemotherapy, she developed rapidly progressing dementia and upper motor neuron signs. Brain MRI showed bilaterally symmetric white matter lesion without gadolinium enhancement. Laboratory investiga-tion showed no evidence of brain metastasis. This case suggests that low dose intravenous methotrexate can induce dif-fuse leukoencephalopathy.

Surgical treatment of aneurysm of the ascending aorta with aortic insufficiency / 대한흉부외과학회지

No abstract available.

Anultrasturctural study on macrophage in granuomatous lesion evoked by methylcellulose

No abstract available.