Dopamine and serotonin alterations by Hizikia fusiformis extracts under in vitro cortical primary neuronal cell cultures

BACKGROUND/OBJECTIVES@#Hizikia fusiformis (HF) is a class of brown seaweeds whose active ingredients exert central nervous system protective effects, such as neuroprotection;however, the underlying mechanisms remain unknown. Given that dopamine (DA) and serotonin (5HT) are two major neurotransmitters involved in various psychiatric disorders and neuronal growth in early neurodevelopmental processes, we investigated whether HF extract could modulate the molecular expression associated with DA and 5HT transmission as well as the structural formation of neurons.MATERIALS/METHODS: in vitro cell cultures were prepared from cerebral cortical neurons obtained from CD-1 mice on embryonic day 14. Cultured cells were treated with 0.1, 1.0, or 10.0 μg/mL of HT extract for 24 h, followed by fluorescence immunostaining for DA and 5HT-related receptors and transporters and some neuronal structural formation-associated molecules. @*RESULTS@#HF extract dose-dependently upregulated the expression levels of selective DA and 5HT receptors, and downregulated the levels of DA and 5HT transporters. Moreover, HF extract increased the neurofilament light chain expression. @*CONCLUSION@#These results suggest that HF may modulate DA and 5HT transmission, thereby affecting neurodevelopment.

Report on the methacholine bronchial provocation test protocol: An updated statement of Korean Academy of Asthma, Allergy and Clinical Immunology

The Korean Academy of Asthma, Allergy, and Clinical Immunology task force report aims to provide new protocols for methacholine challenge test (MCT). Although new devices have different delivery system compared to old ones, previous protocols are still used, which cannot guarantee adequate diagnoses of asthma. Another important issue is the recent recommendation in European Respiratory Society (ERS) technical standard guideline to use a delivered methacholine dose that causes a 20% decrease in forced expiratory volume in 1 second (FEV1) (PD 20). Although the previous protocol based on the methacholine concentration causing a 20% decrease in FEV1 (PC 20) has been used globally, several studies have reported that PD 20 is more reliable and applicable for new protocols of MCT. Indeed, a tidal breathing inhalation protocol using a breath-actuated or continuous nebulizer is recommended. Herein, we recommend 3 protocols for the MCT using new devices and provide a brief summary of the change in strategy based on the updated ERS guideline.

Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

Is Acromial Fracture after Reverse Total Shoulder Arthroplasty a Negligible Complication?: A Systematic Review

BACKGROUND: The purpose of this study was to investigate the incidence of acromial fracture after reverse total shoulder arthroplasty (RTSA) and clinical and radiological outcomes of treatment of the fracture. METHODS: A systematic review was performed to identify studies that reported the results of treatment of acromial fractures after RTSA. A literature search was conducted by two investigators using four databases (PubMed, Embase, Cochrane, and Ovid Medline). RESULTS: Fifteen studies (2,857 shoulders) satisfied our inclusion criteria. The incidence of acromial fracture after RTSA was 4.0% (114 / 2,857). The mean age of the patients at the time of fracture was 72.9 years (range, 51 to 91 years). The mean time from RTSA to diagnosis of acromial fracture was 9.4 months (range, 1 to 94 months). One hundred shoulders (87.7%) were treated conservatively and 14 shoulders (12.3%) were treated surgically. The mean follow-up period after acromial fracture was 33.8 months. The overall union rate was 50.0% (43.8% for conservative treatment and 87.5% for operative treatment). The fracture incidence was significantly different among the medial glenoid and medial humerus prosthesis design (8.4%), the lateral glenoid and medial humerus design (4.0%), and the medial glenoid and lateral humerus design (2.8%). The mean values at final follow-up were as follows: visual analog scale score, 2.2; American Shoulder and Elbow Surgeons score, 59.1; Constant score, 59.7; and Simple Shoulder Test, 5.8. The mean forward flexion, abduction, and external rotation were 102.3°, 92.3°, and 25.8°, respectively. CONCLUSIONS: Acromial fractures after RTSA are a complication neither uncommon nor negligible. In the absence of studies with high-level evidence, there is a controversy on the outcomes after treatment. Further well-designed prospective randomized controlled studies with a long-term follow-up should be performed to ascertain the diagnosis, treatment, and prognosis of acromial fractures after RTSA.

Increment of Serum Free Light Chain Kappa/Lambda Ratio in Patients with Renal Dysfunction

BACKGROUND: Since free light chain (FLC) is metabolized in the kidney, serum FLC concentration and kappa/lambda ratio are increased in patients with decreased renal function, even in the absence of monoclonal protein. In this study, we measured serum FLC levels to investigate the change in kappa/lambda ratios in relation to the severity of renal dysfunction. METHODS: Serum FLC concentrations were measured in 92 archived serum samples from patients diagnosed with chronic kidney disease using the Freelite assay (The Binding Site Group Ltd., UK), and kappa/lambda ratios were calculated. Serum creatinine levels were assayed to calculate estimated glomerular filtration rate (eGFR), and patients were divided into subgroups according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. We analyzed the difference in serum FLC levels and kappa/lambda ratios between subgroups. RESULTS: Serum FLC levels and kappa/lambda ratios increased depending on the severity of renal dysfunction. When patients were classified by setting cut-off value of eGFR as 60 mL/min/1.73 m2 (group A: eGFR ≥60 mL/min/1.73 m2, group B: < 60 mL/min/1.73 m2), the kappa/lambda ratio of group B was significantly higher than that of group A (group B: 1.60±0.46 vs. group A: 1.35±0.27, P=0.018). Serum FLC kappa/lambda ratios were within the previously determined renal reference interval (0.37–3.1). CONCLUSIONS: When interpreting results of serum FLC kappa/lambda ratio, renal function status should be considered in addition to hematological findings. If renal function deteriorates, a wider renal reference interval is preferred instead of the usual reference interval.

Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

Comparison of YD URiSCAN PluScope Urine Microscopic Analyzer and Sysmex UF-1000i Flow Cytometry Systems

BACKGROUND: Urinalysis is one of the most commonly performed tests in clinical laboratories. In this study, we compared YD URiSCAN PluScope (PluScope; YD Diagnostics Corp., Korea) and Sysmex UF-1000i (UF-1000i; Sysmex Corp., Japan) for urine microscopic sediment analysis. METHODS: A total of 404 fresh urine samples were collected and analyzed using PluScope, UF-1000i, and manual microscopy. Quantitative correlation analyses for red blood cells (RBCs), white blood cells (WBCs), epithelial cells (EC), and casts were performed using Spearman's correlation. We evaluated agreement among the three systems by using weighted Cohen's κ and calculating concordance rates within one grade of difference for semiquantitative and qualitative parameters. RESULTS: There were moderate-high correlations between PluScope and UF-1000i for RBCs, WBCs, and ECs (r=0.542, 0.714, and 0.571, respectively) but negligible correlation for casts (r=0.186). There were moderate-high correlations between manual microscopy and automated devices for RBCs, WBCs, and ECs (r=0.550–0.745) but negligible correlations for casts (PluScope: r=0.247; UF-1000i: r=0.223). The pairwise concordance rates within one grade difference among the three methods were good for RBCs, WBCs, and ECs (95.0%–99.0%, κ=0.41–0.74). For casts, the concordance rate between PluScope and manual microscopy was fair (96.8%, κ=0.25), but concordance rates between UF-1000i and manual microscopy and between the two automated devices were poor (81.2% and 81.7%; κ=0.04 and 0.06, respectively). CONCLUSIONS: The two automated urine sediment analyzers showed a moderate-high correlation and concordance rate. They showed good correlations and concordance rates for RBCs, WBCs, and ECs. However, manual microscopic examinations are still needed for reviewing and confirming the presence of pathologic particles in urine, such as casts and crystals.

Suppression of the ERK–SRF axis facilitates somatic cell reprogramming

The molecular mechanism underlying the initiation of somatic cell reprogramming into induced pluripotent stem cells (iPSCs) has not been well described. Thus, we generated single-cell-derived clones by using a combination of drug-inducible vectors encoding transcription factors (Oct4, Sox2, Klf4 and Myc) and a single-cell expansion strategy. This system achieved a high reprogramming efficiency after metabolic and epigenetic remodeling. Functional analyses of the cloned cells revealed that extracellular signal-regulated kinase (ERK) signaling was downregulated at an early stage of reprogramming and that its inhibition was a driving force for iPSC formation. Among the reprogramming factors, Myc predominantly induced ERK suppression. ERK inhibition upregulated the conversion of somatic cells into iPSCs through concomitant suppression of serum response factor (SRF). Conversely, SRF activation suppressed the reprogramming induced by ERK inhibition and negatively regulated embryonic pluripotency by inducing differentiation via upregulation of immediate early genes, such as c-Jun, c-Fos and EGR1. These data reveal that suppression of the ERK-SRF axis is an initial molecular event that facilitates iPSC formation and may be a useful surrogate marker for cellular reprogramming.

Compartment Syndrome of the Upper Extremity Induced by Extravasation of Contrast Media after Computed Tomography: A Case Report

The incidence of contrast media extravasation has been increasing gradually. Most contrast media extravasations only can cause pain, swelling and erythema. However, in more severe cases, skin necrosis, ulceration, or compartment syndrome may occur, often necessitating a surgery. Early diagnosis and treatment should be established on the spot in order to avoid such a severe damage. We present a case of 42-year-old woman with a compartment syndrome in the right upper extremity caused by extravasation of computed tomography contrast media.

Compartment Syndrome of the Upper Extremity Induced by Extravasation of Contrast Media after Computed Tomography: A Case Report

The incidence of contrast media extravasation has been increasing gradually. Most contrast media extravasations only can cause pain, swelling and erythema. However, in more severe cases, skin necrosis, ulceration, or compartment syndrome may occur, often necessitating a surgery. Early diagnosis and treatment should be established on the spot in order to avoid such a severe damage. We present a case of 42-year-old woman with a compartment syndrome in the right upper extremity caused by extravasation of computed tomography contrast media.

Radiological Stability after Revision of Infected Total Knee Arthroplasty Using Modular Metal Augments

PURPOSE: To evaluate the radiological stability according to the number of modular augments after revision of infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Between February 2006 and September 2013, 37 patients (39 knees) followed > or =2 years after revision of infected TKA using modular metal augments for bone defects were reviewed retrospectively. We divided the patients into 3 groups according to the number of augments into group A ( or = augments, 7 knees) and evaluated the width of radiolucent zones around the implant at the last follow-up. RESULTS: There were 3 Anderson Orthopedic Research Institute type I, 33 type II, and 3 type III bone defects. The mean number of radiolucent zones of group A was 3 and the sum of width averaged 4.4 mm. In group B, the values were 4.8 and 6.2 mm, respectively. In group C, the values were 8.1 and 12.9 mm, respectively. The differences between the three groups were statistically significant. CONCLUSIONS: In revision TKA with modular metal augmentation caused by infected TKA, increased modularity can result in radiological instability.

Giant Brunner’s Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction

Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

Tracheal Involvement in Crohn Disease: the First Case in Korea

Respiratory involvement in Crohn disease (CD) is rare condition with only about a dozen reported cases. We report the first case of CD with tracheal involvement in Korea. An 18-year-old woman with CD was hospitalized because of coughing, dyspnea, and fever sustained for 3 weeks. Because she had stridor in her neck, we performed computed tomography of the neck, which showed circumferential wall thickening of the larynx and hypopharynx. Bronchoscopy revealed mucosal irregularity, ulceration, and exudates debris in the proximal trachea, and bronchial biopsy revealed chronic inflammation with granulation tissue. Based on these findings, we suspected CD with tracheal involvement and began administering intravenous methylprednisolone at 1 mg/kg per day, after which her symptoms and bronchoscopic findings improved.

Erratum: Tracheal Involvement in Crohn Disease: the First Case in Korea

The publisher wishes to apologize for incorrectly displaying the author (Ju Hyung Lee) name.

Allergic Reaction to Meperidine in a Patient with Aspirin Idiosyncrasy / 대한내과학회지

Although narcotic analgesics are potent releasers of histamine, IgE-mediated allergic reactions to these drugs are rare. Here we report the case of a 56-year-old male who suffered from chronic urticarial and analgesics-induced skin rashes. He visited our allergy clinic to determine alternative analgesics before undergoing surgery. A drug provocation test showed a positive reaction to aspirin, but negative reactions to acetaminophen and celecoxib. Despite careful attention to his drug regimen, during surgery he developed generalized urticaria and flushing. Skin tests of allergy to latex, lidocaine, propofol, rocuronium, flomoxef, meperidine, palonosetron, pyridostigmine, and fentanyl yielded negative results, except for the prick and intradermal tests with meperidine. Thus, this patient had both an aspirin/non-steroidal anti-inflammatory drugs idiosyncrasy and an IgE-mediated hypersensitivity to meperidine.

Gender Affects Early Postoperative Outcomes of Rotator Cuff Repair

BACKGROUND: The literature does not provide consistent information on the impact of patients' gender on recovery after rotator cuff repair. The purpose of this study was to determine whether gender affects pain and functional recovery in the early postoperative period after rotator cuff repair. METHODS: Eighty patients (40 men and 40 women) were prospectively enrolled. Pain intensity and functional recovery were evaluated, using visual analog scale (VAS) pain score and range of motion on each of the first 5 postoperative days, at 2 and 6 weeks and at 3, 6, and 12 months after surgery. Perioperative medication-related adverse effects and postoperative complications were also assessed. RESULTS: The mean VAS pain score was significantly higher for women than men at 2 weeks after surgery (p = 0.035). For all other periods, there was no significant difference between men and women in VAS pain scores, although women had higher scores than men. Mean forward flexion in women was significantly lower than men at 6 weeks after surgery (p = 0.033) and the mean degree of external rotation in women was significantly lower than men at 6 weeks (p = 0.007) and at 3 months (p = 0.017) after surgery. There was no significant difference in medication-related adverse effects or postoperative complications. CONCLUSIONS: Women had more pain and slower recovery of shoulder motion than men during the first 3 months after rotator cuff repair. These findings can serve as guidelines for pain management and rehabilitation after surgery and can help explain postoperative recovery patterns to patients with scheduled rotator cuff repair.

Case of Multiple Liver Lacerations Detected After Cardiopulmonary Resuscitation

The liver is one of the most commonly injured organs by blunt or penetrating abdominal trauma. The incidence of injuries is increasing annually as a result of the high number of traffic accidents. The mortality of this injury is almost 15% and the most common cause of death is hemorrhage. But, liver injuries during cardiopulmonary resuscitation are rare complications. These liver injuries can be managed and treated by non-operatively. We reported a case of multiple liver lacerations that was detected incidentally and was treated with non-operative management.

A Case of Liver Abscess and Bacteremia Caused by Vibrio cholerae Non-O1 / 대한소화기학회지

Vibrio cholerae non-O1 have caused several well-studied food-borne outbreaks of gastroenteritis and also have been responsible for sporadic cases of otitis media, wound infection, and bacteremia. Few cases of liver abscess caused by Vibrio cholerae non-O1 have been reported. A 73-year-old man with underlying diabetes mellitus was admitted with nausea, vomiting, dyspepsia and febrile sensation. We identified Vibrio cholerae non-O1 in his blood cultures and multiple hepatic microabscess on abdominal computed tomography. He was treated with systemic antibiotics and fluid therapy, but died due to septic shock on sixth day. We report here, a case of liver abscess with bacteremia due to Vibrio cholerae non-O1 in a patient with diabetes mellitus.

A Case of Henoch-Schonlein Purpura Complicated by Acute Pancreatitis and Interstitial Pneumonitis

Henoch-Schonlein purpura (HSP) is a systemic vasculitis involving the skin, gut, joint and kidney that is characterized by immunoglobulin A (IgA)-dominant immune deposits in target organs. Gastrointestinal involvement is known to be relatively common, but acute pancreatitis and pulmonary involvement are rare in Henoch-Schonlein purpura. We experienced a case of a 46-year-old man who developed adult-onset HSP complicated by acute pancreatitis and interstitial pneumonitis. The patient received corticosteroid therapy at a dosage of 0.5 mg/kg. After corticosteroid therapy, patient's symptoms improved. We report here the first case of HSP complicated by acute pancreatitis and interstitial pneumonitis.

CREB-Phosphorylation as a Predictor of Therapeutic Response to Antidepressants

OBJECTIVES: CREB (c-AMP response element binding protein) is known as a key mediator of the therapeutic response to antidepressants. We investigated the change of CREB-phosphorylation (pCREB) at the early point of the fluoxetine treatment to find out it can be a predictor for antidepressant response. METHODS: We evaluated the pCREB of T - lymphocyte nuclear extracts from 18 depressed patients at 0 and 1th week during fluoxetine treatment (20 mg/day). Responders were defined as the > or = 50% reduction of HAM-D score in 4 weeks. We compared the changes of pCREB at 0 and 1th week between responders and non-responders. RESULTS: The responders showed a significant increase of pCREB at week 1 compared with week 0. The HAM-D difference between week 0 and 4 was positively correlated with the change of pCREB response. CONCLUSION: These results suggest that the early change of pCREB in peripheral lymphocyte can predict the later response of antidepressant. The correlation showed pCREB directly reflects a response status to the antidepressant fluoxetine and clinical improvement.