Toll-like receptor 2 promotes neurogenesis from the dentate gyrus after photothrombotic cerebral ischemia in mice

The subgranular zone (SGZ) of hippocampal dentate gyrus (HDG) is a primary site of adult neurogenesis. Toll-like receptors (TLRs), are involved in neural system development of Drosophila and innate immune response of mammals. TLR2 is expressed abundantly in neurogenic niches such as adult mammalian hippocampus. It regulates adult hippocampal neurogenesis. However, the role of TLR2 in adult neurogenesis is not well studied in global or focal cerebral ischemia. Therefore, this study aimed to investigate the role of TLR2 in adult neurogenesis after photochemically induced cerebral ischemia. At 7 days after photothrombotic ischemic injury, the number of bromodeoxyuridine (BrdU)-positive cells was increased in both TLR2 knock-out (KO) mice and wild-type (WT) mice. However, the increment rate of BrdU-positive cells was lower in TLR2 KO mice compared to that in WT mice. The number of doublecortin (DCX) and neuronal nuclei (NeuN)-positive cells in HDG was decreased after photothrombotic ischemia in TLR2 KO mice compared to that in WT mice. The survival rate of cells in HDG was decreased in TLR2 KO mice compared to that in WT mice. In contrast, the number of cleaved-caspase 3 (apoptotic marker) and the number of GFAP (glia marker)/BrdU double-positive cells in TLR2 KO mice were higher than that in WT mice. These results suggest that TLR2 can promote adult neurogenesis from neural stem cell of hippocampal dentate gyrus through increasing proliferation, differentiation, and survival from neural stem cells after ischemic injury of the brain.

Preliminary Study for a Multicenter Study of Alzheimer's Disease Cerebrospinal Fluid Biomarkers

BACKGROUND: The usefulness of cerebrospinal fluid (CSF) concentrations of amyloid beta protein 1-42 (Abeta42), phosphorylated tau (pTau) and total tau (tTau) have been increasing in Alzheimer's disease (AD). However, the direct adoption of previously reported standard values is not appropriate due to interlaboratory variability. We started this study to set up an accessible system to measure CSF biomarkers in our country with high reproducibility and validity. METHODS: Including CSFs from four different institutes the levels of Abeta42, pTau181 and tTau were measured in one lab. The intertest variability and difference in the levels of biomarkers depending on diseases were assessed. Through analysis of receiver operating characteristic cut points and binary logistic regression the cut-off values of Abeta42, pTau and tTau level were obtained, and their validity was evaluated. RESULTS: The intertest consistency was high in measuring CSF biomarkers. The value of Abeta42 was markedly decreased in AD (n= 17) and other dementia (n= 9) compared to normal control (n= 12). The levels of pTau181 and tTau were high in AD, but not in other dementia and normal control. The threshold values of Abeta42, pTau181 and tTau were 290.3 pg/mL, 54.3 pg/mL, and 320.7 pg/mL in differentiating AD from normal control showing high sensitivity and specificity. Especially, the ratios of pTau181/Abeta42 (> 0.16) and tTau/Abeta42 (> 0.76) showed the prime validity. CONCLUSIONS: Our data of CSF Abeta42, pTau181, and tTau levels were highly reproducible. PTau181/Abeta42 and tTau/Abeta42 ratios were the greatly helpful in differentiating AD from normal control.

Nationwide Survey on the Current Status of Infection Control in Oriental Medical Hospitals / 병원감염관리

BACKGROUND: Oriental medicine is a part of medical service in Korea. However, there are no information about the status of infection control program in oriental medical hospitals. The purpose of this study was to investigate the current status of infection control activities in oriental medical hospitals and to provide a data to establish infection control policy in oriental medical hospitals. METHODS: This study was based on the survey questionnaires about infection control program and activities with total 13 oriental medical university hospitals in Korea. Questionnaires were collected from February 1 to March 31, 2011. RESULTS: Nine hospitals (69.2%) had infection control practitioner (ICP). Only 4 hospitals (30.8%) had full-time ICP and infection control office. The 6 hospitals (46.2%) had a position for infection control doctor and half of them were oriental medical doctors. Eight hospitals (61.5%) had an infection control committee and they had a meeting for average 2.5 times a year. Six hospitals (46.2%) performed surveillance and most of them were monitoring site directed infections. Only 4 hospitals have microbiology laboratory. All hospitals were using disposable acupuncture needles. Six hospitals were only using disposable wet cupping. Two hospitals (15.4%) were reusing wet cupping after disinfection. CONCLUSION: Through this study it was able to find out the status of infection control activities in oriental hospitals. There were also many limits on infection control activities in oriental medical hospitals. Based on this study it is needed to develop the infection control guideline and education for associates in oriental hospitals.

Changes of Blood Pressure during Endoscopy

BACKGROUND: The burden of cardiac complications during endoscopy are growing due to increasing proportion of elderly in the endoscopy target population. This study was conducted to examine the blood pressure changes before and after the endoscopy and to seek better pre-treatments in minimizing cardiac complications. METHODS: One hundred subjects were chosen by consecutive sampling who visited a general hospital for physical examination. Basal, pre-endoscopic, immediate post-endoscopic blood pressure and blood pressure after 10 and 30 minutes were measured utilizing manual BP cuffs and recorded. RESULTS: The subjects included 34 hypertensive patients. Twelve subjects were on anti hypertensive medication. In 5 consecutive measurements, significant variations on blood pressure was noted (P<0.01). Blood pressure kept increasing until immediately after the procedure, followed by a gradual reduction. These changes were observed in both the normotensive and the hypertensive group, but the degree of changes were more pronounced in the hypertrensive group than the normotensive group (P<0.01). The difference between basal and after procedure was 17.6 mmHg for systolic, 13.5 mmHg for diastolic in the normotensive group. However in the hypertensive group, the difference was 21.4 mmHg for systolic, 14.8 mmHg for diastolic. In comparison of medicated and non-medicated group in the hypertensive patients, the degree of changes were marginally, but significantly lower in the treatment group than in the non-treatment group (systolic P=0.056, diastolic P=0.049). CONCLUSION: The stress during endoscopy resulted in blood pressure changes, and the degree of changes was higher in the hypertensive group than the normotensive group. In the hypertensive group, the degree of changes was lower in patients treated with anti hypertensives than the non-treated patients. This sample size, however, was small.

A case of non small cell lung cancer presenting with systemic lupus erythematosus(SLE) / 대한내과학회지

No abstract available.

A Study of 162 Cases of Peri-Ampullary Diverticulum / 대한소화기내시경학회지

BACKGROUND: Periampullary diverticulum has been commonly discovered during endoscopic retrograde cholangiopancreatography(ERCP) in patients with various pancreaticobiliary diseases such as cholelithiasis and its clinical significance has been noted. Recently, periampullary diverticulum is known to be associated with choledocholithiasis, various pancreatobiliary diseases and intestinal symptoms. Our aims of study was to investigate characteristics of periampullary diverticulum and to determinate the positive relationship between periampullary diverticulum and choledocholithiasis, and to determinate whether periampullary diverticulum influences on the cannulation rate and complication performing ERCP and endoscopic sphincterotomy(EST). METHODS: We reviewed 162 of 594 cases, which had periampullary diverticulums on ERCP during the past 6 years, and investigated size, location and number of periampullary diverticulums with special reference to the location of cholelithiasis. We also compared success rate and complication rate of ERCP and EST in cases with or without periamullary diverticulum. RESULTS: The incidence of periampullary diverticulum was 27.3%(male 48.1%, female 51.9%). and increased after 50 years old. In anatomical characteriastics of periampullary diverticulum, most of the diverticulum was single(90.1%). Size was usually smaller than 1cm(48.8%) and was seperated from ampulla of Vater, type III(59.2%). Choledocholithiasis was more frequently found in patients with periampullary diverticulum(58.9%) than in patients without diverticulum(43.1), especially in type II(attatching type). Failure rate of ERCP was 14.8% with periampullary diverticulum and was 14.6% without it. Bleeding, one of serious complications of EST, was noted in 4 patients with periampullary diverticulum, and one patient was operated to control the bleeding. CONCLUSIONS: Periampullary diverticulum might be related with choledocholithiasis, but usually does not interfere with procedure of ERCP.

The Effect of Neoadjuvant Chemotherapy with 5-Fluorouracil (5-FU), Vinblastine and Cisplatin (FVP) for Stage III Non-Small Cell Lung Cancer (NSCLC) / 대한암학회지

PURPOSE: As the prognosis of stage III NSCLC is still poor with or without operation, we conducted a phase II trial of neoadjuvant chemotherapy (CHT) with 5-FU, vinblastine, cisplatin prior to surgery to determine the effect on resectability and survival. MATERIALS AND METHOD: Patients (pt) received 5-FU 500mg/m2/12 hours continuous infusion for 36 hours, vinblastine 3mg/m2/day iv bolus day 1 and day 2, and cisplatin 75mg/m2 iv day 1 every 3 weeks. This regimen was given for 2 cycles. When the tumor was responsive (stable disease or better), 1 or 2 more cycles of the CHT were given, followed by operation when totally resectable on chest CT/MRI, then 3 more cycles of the CHT to finish the treatment; when the tumor was neither responsive nor resectable after 3rd or 4th CHT, radiotherapy was started. RESULT: Twenty nine pt were enrolled and 26 pt have been evaluable so far. Age ranged from 32 to 79 (median 59 years); 23 were male, 3 female. Total of 108 cycles were given (mean 4.2). There were 4 partial remissions out of 6 IIIAs (67%) and 10 out of 20 IIIBs (50%), with overall response rate of 53.8%; down staging was noted in 9 patients (34.6%). 9 pt (34.6%) underwent curative resection successfully; 4 out of 6 IIIAs (67%) and 5 out of 20 IIIBs (25.0%); 1 patient refused operation. Median survival was 31.3 months for 9 pt with operation, and that of all patients was 14.2 months. Radiation was given to 9 pt, resulting in 3 partial remissions (PR), 3 stable diseases (SD), 3 progressive diseases (PD). Serious (WHO grade> or =3) toxicities were nausea/emesis in 2.8%, granulocytopenia in 26.9% and thrombocytopenia in 2.8%. CONCLUSION: This treatment modality seemed to be effective, encouraging further phase III study for better determination of its role.

Acute Inferior Wall Myocardial Infarction as a Result of Anomalous Origin of the Right Coronary Arteryl from the Left Simus of Valsalva

The incidence of anomalous aortic origin of the coronary arteries in the general papulation is unknown. In recent reports from various laboratories, the incidence was between 0.6-12% in patients referred for coronary arteriogtaphy. Anomalous origin of the right coronary artery from the left sinus of Valsalva is reported to constitute from 6% to 27% of all coronary anomalies, For many years pathologists classified it as a minor anomaly of no clinical importance. Recently, manifstations of myocardial ischemia have been described in patients with this anomaly in the absence of additional atherosclerotic or other disease processes. These manifestations have included acute myocardial infarction, angina pectoris, syncope, nonfatal ventricular fibrillation, and sudden death. We report a case of 56-year-old male with the anomalous origin of the right coronary artery from the left sinus of Valsalva, who had been admitted due to severe substernal chest pain and acute inferior wall myocardial infarction. The coronary angiography revealed that the right coronary artery originated from the left coronary sinus without significant atheroscleotic narrowing. The anomalous right coronary artery passed anteriorly between pulmonary artery and aortic root without significant coronary obstruction.

Post-operative Adjuvant Chemotherapy with 5-Fluorouracil, Leucovorin, and Mitomycin C (MLF) for Gastric Cancer / 대한암학회지

PURPOSE: The surgical resection has been still the only curative treatment modality for the gastric cancer, but the overall prognosis has not been so satisfactory because of high relapse rate. So the necessity of adjuvant chemotherapy has been increased. We evaluated the effect of MLF (5-fluorouracil, leucovorin and mitomycin C) regimen on the prevention of relapse and survival benefit after postopertive adjuvant chemotherapy. MATERIALS AND METHOD: The MLF regimen consisted of 5-FU 375 mg/m2 IV on days 1 through 5; LV 20 mg/m2 IV just before 5-FU infusion on days 1 through 5; and MMC 9 mg/m2 IV on day 1 (7 mg/m2 from the 2nd cycle). RESULTS: One hundred patients were entered into the trial; 56 were male & 44 female, and the range of age was 20 to 82. The total number of chemotherapy cycles was 514. According to AJCC staging, 4 cases were in stage IA, 14 IB, 23 II, 42 IIIA, 15 IIIB, respectively and 2 cases were in stage IV. The estimated median survival was 32 months in stage IIIA, and 28 months in IIIB. The 5 year survival was 90% in stage IB, 76% in II, 29.6% in IIIA and 21.8% in IIIB. Severe neutropenia (WHO grade > or = 3) was observed in 11.8%, and throbocytopenia 0.4%. Severe nausea and vomiting was observed in 1.8%, diarrhea in 1.7%, and mucositis in 1.5%, but there was no toxic death. CONCLUSION: The MLF adjuvant chemotherapy may be effective for resectable gastric cancer with minimal toxicities, but phase III study is needed to confirm its efficacy.

A Case of Disulfiram Neuropathy

Disulfiram, tetraethylthiuram disulfide, has been used in the clinical treatment of alcoholism since 1948. Aside from the manifestations of a disulfiram-alcohol reaction, disulfiram causes direct toxic side effects including psychiatric, cardiovascular, hematologic and neurologic disorders. The most frequent neurologic side effects are drowsiness, apathy, headache, decreased sexual potency, neuropathy, and optic neuritis. We describe a 26-year-old man who insidiously developed a distal synunetric sensorimotor polyneuropathy after seven years of disulfiram ingestion confirmed by nerve biopsy. He showed nearly complete resolution after the disulfiram was stopped.

A Case of Primary Leptomemngeal Melanoma

Primary leptomeningeal melanoma is a rare and aggressive tumor that originates from pial melanin-bearing cells typically along the cerebral conveidties or at the. Base of the brain. It has been hypothesized that malignant transformation Of the preexisting precursor cells leads to diffuse infiltration of the meninges by tumor and the onset of neurological symptoms and signs . The typical neurological symptoms and signs include psychiatric disturbances, seizures, and symptoros and signs of raised intracranial pressure secondary to hydrocephalus. Blindness has been reported as a late feature. Radiotherapy and chemotherapy has been using, but prognosis is poor We d be our experience with 24-years-woman in which the diagnosis of primary leptomeningea1 melanoma without melanotic pigmentation of variable areas of the skm was made.

A case of Spontaneous Intracranial Hypotension Treated with Epidural Blood Patch

Spontaneous intracranial hypotension, a syndrome of low CSF pressure, occurs without preceding events such as lumbar puncture, back trauma, operative procedure or medical illness. The most characteristic symptom is a headache that may be severe when the patient is upright and relieved when the patient is recumbent. Associated symptoms include neck stiffness, nausea and vomiting, tinnitus, vertigo and subdural effusion or hematoma. This syndrome usually resolves spontaneously or with strict bed rest. When the headache persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of spontaneous intracranial hypotension. We report a case of spontaneous intracranial hypotension successfully treated with epidural blood patch.

A Case of Idiopathic Intracranial Hypertension Treated with Optic Nerve Sheath Fenestration

Idiopathic intracranial hypertension, a syndrome of obscure origin, occurs particularly in fat adolescent girls and young women. The usual symptoms are headache, blurred vision, a vague dizziness, horizontal diplopia and transient visual obscurations etc., and ophthalmoscopic examination reveals papillederma, due to increased ICP. Visual field testing usually shows slight peripheral constrictions with enlargement of the blind sports. CSF pressure is elevated in the range of 250 to 450 mm of water. Radiological or the other laboratory tests show no specific abnormalities. Treatment for idiopathic intracranial hypertension is focused on early detection and prevention of vision loss, the only permanent morbidity. Many different modes of medical treatment, including weight reduction, repeated lumber puncture, corticosteroids, diuretics, glycerol or carbonic anhydrase inhibitors, have successfully been tried up to 90% of the patients. In the remaining patients, particularly in those with measurable impairment of vision that does not respond to conventinal medical therapies, surgical procedure should be considered. We report a case of idiopathic intracranial hypertension successfully treated with optic nerve sheath fenestration.