The clinical and microbiological effects of non-surgical periodontal treatments in necrotizing periodontal disease: case report

Necrotizing periodontal disease caused by plaque bacteria is showed clinical findings including pseudo-membrane, interproximal necrosis of the affected area, pain on palpation and gingiva bleeding. Microbiological examination is showed that patients have fusospirochetal bacteria. Two patients who were provisionally diagnosed as necrotizing periodontal disease received nonsurgical periodontal treatments in conjunction with dressing using 3% hydrogen peroxide and local antibiotic delivery. Before and 3 - 5 days after initial treatment, the levels of periodontal bacteria in gingival crevicular fluid obtained using quantitative PCR were compared. After treatment, patients recovered normal gingiva. The number of periodontal diseases related bacterial species decreased from seven or eight to one. As a result, periodontium of patients with necrotizing periodontal disease was recovered to normal periodontium by nonsurgical periodontal treatments.

Clinical significance of microscopic hematuria and hydronephrosis in ureteral calculi patients visiting emergency department

OBJECTIVE: This study examined the clinical significance of microscopic hematuria and grade of hydronephrosis in ureteral calculi patients visiting the emergency department (ED). METHODS: The EDs of two medical centers were reviewed retrospectively from August 1, 2012 to July 31, 2017. The total ureteral calculi patients were 2,069 and 1,593 patients were analyzed after exclusion. The normal range of microscopic hematuria in both medical centers was 0–5/high power field (HPF) of red blood cell in urinalysis. Therefore, microscopic hematuria more than 5/HPF was defined as positive. The size of the stone, grade of hydronephrosis (normal, mild, moderate, and severe) and location of ureteral calculi in the non-contrast abdomen and pelvis computed tomography (CT) was measured by one person at each medical center using same method. The patients with or without microscopic hematuria and grade of hydronephrosis were then compared. RESULTS: The median size of the ureteral calculi patients without and with microscopic hematuria was 5.4 mm (range, 3.8–9.0 mm) and 4.0 mm (range, 3.0–5.8 mm) (P < 0.001). The patients grouped as normal to mild, and moderate to severe hydronephrosis, without microscopic hematuria was 191 (16.5%) and 91 (20.9%), respectively. On the other hand, microscopic hematuria was 966 (83.5%) and 345 (79.1%) (P=0.042). According to the location of ureteral calculi, with and without microscopic hematuria was 81.9% and 18.1% in the upper ureter, 82.9% and 17.1% in the mid ureter, and 82.6% and 17.4% in the lower ureter, respectively (P=0.935). CONCLUSION: The median size of the stone and grade of hydronephrosis were related to microscopic hematuria but the location of the ureteral calculi was not related. Therefore, in cases without microscopic hematuria in suspected ureteral calculi, clinicians should check the abdomen and pelvis CT for an accurate diagnosis and treatment of ureteral calculi.

Effects of intubation with a double-lumen endotracheal tube on intraocular pressure during rapid sequence induction using succinylcholine chloride in patients with or without underlying systemic hypertension

BACKGROUND: Tracheal intubation is closely associated with increases in intraocular pressure (IOP); however, the effects of double-lumen tube (DLT) intubation on IOP have not been validated. Systemic hypertension (HTN) is another factor that may increase IOP. In this study, we observed differences in IOP increases between DLT and single-lumen tube (SLT) intubation, and evaluated the influence of underlying HTN during rapid sequence induction.METHODS: Sixty-eight patients were allocated into one of the following group: SLT/without HTN (n = 17), SLT/HTN (n = 17), DLT/without HTN (n = 17), and DLT/HTN (n = 17). An SLT was inserted for orthopedic or gynecological surgery, and a DLT was inserted for lung surgery after rapid sequence induction using succinylcholine. IOP was measured before anesthetic induction and until 10 min after intubation using a handheld tonometer (Tono-Pen AVIA®).RESULTS: In the DLT/without HTN and DLT/HTN groups, the maximum increases in IOPs after tracheal intubation were 7.9 and 12.2 mmHg, respectively, compared to baseline. In the SLT/without HTN and SLT/HTN groups, the maximum increases were 5.0 and 4.9 mmHg, respectively, compared to baseline. In comparisons between patients with and without underlying HTN, the values of IOPs were comparable.CONCLUSIONS: Tracheal intubation with a DLT is associated with more increases in IOPs than with an SLT in rapid sequence induction. Well-controlled underlying hypertension did not increase IOP during tracheal intubation.

The implication of using dominant hand to perform laryngoscopy: an analysis of the laryngoscopic view and blade-tooth distance

BACKGROUND: Existing laryngoscopes are designed to be handled by the left hand, whereas most healthcare professionals are right-handed. However, controlling the laryngoscope device requires considerable strength and refinement to control the blade. We examined the usefulness of a right-handed laryngoscope to validate its clinical applicability. METHODS: One hundred sixty-four patients for general anesthesia were involved. Laryngoscopy was performed twice for each patient, once using a conventional left-handed Macintosh No. 3 laryngoscope and once using a right-handed one, by 25 right-handed and 18 left-handed laryngoscopists. The perpendicular distance from the tip of the maxillary incisor to the flange of each blade was measured when the maximum visibility of the glottis was obtained. We compared the distances, chances of directly contacting the tooth, laryngoscopic views and subjective feeling of difficulty in handling device between the two laryngoscopes. RESULTS: For the right-handed laryngoscopists, distance varied significantly between the two laryngoscopes (5.0 ± 3.5 and 5.7 ± 3.7 mm [mean ± standard deviation] for the conventional and right-handed laryngoscopes, respectively [P < 0.001]). The right-handed laryngoscope was associated with a decreased chance of directly contacting the teeth (P = 0.001). Additionally, the right-handed laryngoscope provided a better view than the conventional one (P = 0.005). Conversely, most of the left-handed laryngoscopists felt that the procedure using a conventional laryngoscope was easier than with a right-handed one. CONCLUSIONS: When a right-handed laryngoscopist uses a right-handed laryngoscope, a better laryngoscopic view and a reduced chance of blade contact with the teeth can be achieved.

Protective effects of perilla oil and alpha linolenic acid on SH-SY5Y neuronal cell death induced by hydrogen peroxide

BACKGROUND/OBJECTIVE: Oxidative stress plays a key role in neuronal cell damage, which is associated with neurodegenerative disease. The aim of present study was to investigate the neuroprotective effects of perilla oil (PO) and its active component, alpha-linolenic acid (ALA), against hydrogen peroxide (H₂O₂)-induced oxidative stress in SH-SY5Y neuronal cells. MATERIALS/METHODS: The SH-SY5Y human neuroblastoma cells exposed to 250 µM H₂O₂ for 24 h were treated with different concentrations of PO (25, 125, 250 and 500 µg/mL) and its major fatty acid, ALA (1, 2.5, 5 and 25 µ/mL). We examined the effects of PO and ALA on H₂O₂-induced cell viability, lactate dehydrogenase (LDH) release, and nuclear condensation. Moreover, we determined whether PO and ALA regulated the apoptosis-related protein expressions, such as cleaved-poly ADP ribose polymerase (PARP), cleaved caspase-9 and -3, BCL-2 and BAX. RESULTS: Treatment of H₂O₂ resulted in decreased cell viability, increased LDH release, and increase in the nuclei condensation as indicated by Hoechst 33342 staining. However, PO and ALA treatment significantly attenuated the neuronal cell death, indicating that PO and ALA potently blocked the H₂O₂-induced neuronal apoptosis. Furthermore, cleaved-PARP, cleaved caspase-9 and -3 activations were significantly decreased in the presence of PO and ALA, and the H₂O₂-mediated up-regulated BAX/BCL-2 ratio was blocked after treatment with PO and ALA. CONCLUSIONS: PO and its main fatty acid, ALA, exerted the protective activity from neuronal oxidative stress induced by H₂O₂. They regulated apoptotic pathway in neuronal cell death by alleviation of BAX/BCL-2 ratio, and down-regulation of cleaved-PARP and cleaved caspase-9 and -3. Although further studies are required to verify the protective mechanisms of PO and ALA from neuronal damage, PO and ALA are the promising agent against oxidative stress-induced apoptotic neuronal cell death.

Antiplatelet and Antithrombotic Effects of the Extract of Lindera obtusiloba Leaves

Lindera obtusiloba has been used in traditional herbal medicine for the treatment of blood stasis and inflammation. The leaves of Lindera obtusiloba have been reported to exhibit various physiological activities. However, there is little information available on their antiplatelet and antithrombotic activities. Thus, the present study aimed to evaluate the effect of Lindera obtusiloba leaf extract (LLE) on platelet activities, coagulation and thromboembolism. In a platelet aggregation study, LLE significantly inhibited various agonist-induced platelet aggregations in vitro and ex vivo. Furthermore, LLE significantly inhibited collagen-induced thromboxane A2 (TXA2) production in rat platelets. In addition, oral administration of LLE was protective in a mouse model of pulmonary thromboembolism induced by intravenous injection of a mixture of collagen and epinephrine. Interestingly, LLE did not significantly alter prothrombin time (PT) and activated partial thromboplastin time (aPTT). This study indicates that the antithrombotic effects of LLE might be due to its antiplatelet activities rather than anticoagulation. Taken together, these results suggest that LLE may be a candidate preventive and therapeutic agent in cardiovascular diseases associated with platelet hyperactivity.

Yield Analysis of Flavonoids in Acanthopanax divaricatus and A. koreanum Grown using Different Cultivation Methods

High-performance liquid chromatography was performed in order to analyze the changes in the flavonoid content (rutin, hyperin, afzelin, quercetin, and kaempferol) of Acanthopanax divaricatus and A. koreanum, in response to different cultivation methods (pinching height, planting time, and top dressing). The total flavonoid content of A. divaricatus and A. koreanum ranged from 0.201 to 0.690 mg/g with different pinching heights, 0.143 to 1.001 mg/g for different planting times, and 0.156 to 1.074 mg/g depending on the rate of fertilizer application. In both A. divaricatus and A. koreanum, the total flavonoid content in the upper section of the plant was greater than that in the lower section. These results demonstrate which cultivation methods maximize the flavonoid content of A. divaricatus and A. koreanum, and thus help to optimize flavonoid yields to improve production for nutraceutical, pharmaceutical, and cosmeceutical applications.

The Neuro-Protective Effect of the Methanolic Extract of Perilla frutescens var. japonica and Rosmarinic Acid against H2O2-Induced Oxidative Stress in C6 Glial Cells

Neurodegenerative diseases are often associated with oxidative damage in neuronal cells. This study was conducted to investigate the neuro-protective effect of methanolic (MeOH) extract of Perilla frutescens var. japonica and its one of the major compounds, rosmarinic acid, under oxidative stress induced by hydrogen peroxide (H2O2) in C6 glial cells. Exposure of C6 glial cells to H2O2 enhanced oxidative damage as measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and thiobarbituric acid-reactive substance assays. The MeOH extract and rosmarinic acid prevented oxidative stress by increasing cell viability and inhibiting cellular lipid peroxidation. In addition, the MeOH extract and rosmarinic acid reduced H2O2-induced expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) at the transcriptional level. Moreover, iNOS and COX-2 protein expression was down-regulated in H2O2-indcued C6 glial cells treated with the MeOH extract and rosmarinic acid. These findings suggest that P. frutescens var. japonica and rosmarinic acid could prevent the progression of neurodegenerative diseases through attenuation of neuronal oxidative stress.

Obesity and hepatocellular carcinoma in patients receiving entecavir for chronic hepatitis B

BACKGROUND/AIMS: This study aimed to clarify the effect of obesity on the development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients receiving antiviral treatment. METHODS: This study applied a retrospective analysis to a historical cohort in Bundang Jesaeng Hospital. In total, 102 CHB patients were treated with entecavir as an initial treatment for CHB and checked for obesity using a body composition analyzer. Hepatic steatosis was measured semiquantitatively using Hamaguchi’s scoring system in ultrasonography. Risk factors for the development of HCC were analyzed, including obesity-related factors (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], visceral fat area [VFA], and hepatic steatosis). RESULTS: The median follow-up duration of the patients was 45.2 months (interquartile range: 36.0-58.3 months). The cumulative incidence rates of HCC at 1 year, 3 years, and 5 years were 0%, 5.3%, and 9.0%, respectively. Univariable analysis revealed that the risk factors for HCC development were a platelet count of <120,000 /mm² (hazard ratio [HR]=5.21, P=0.031), HBeAg negativity (HR=5.61, P=0.039), and liver cirrhosis (HR=10.26, P=0.031). Multivariable analysis showed that the significant risk factor for HCC development was liver cirrhosis (HR=9.07, P=0.042). However, none of the obesity-related risk factors were significantly associated with HCC: BMI ≥25 kg/m² (HR=0.90, P=0.894), WC ≥90 cm (HR=1.10, P=0.912), WHR ≥0.9 (HR=1.94, P=0.386), VFA ≥100 cm² (HR=1.69, P=0.495), and hepatic steatosis (HR=0.57, P=0.602). CONCLUSION: HCC development is associated with liver cirrhosis but not obesity-related factors in CHB patients receiving entecavir.

CTHRC1 promotes angiogenesis by recruiting Tie2-expressing monocytes to pancreatic tumors

CTHRC1 (collagen triple-helix repeat-containing 1), a protein secreted during the tissue-repair process, is highly expressed in several malignant tumors, including pancreatic cancer. We recently showed that CTHRC1 has an important role in the progression and metastasis of pancreatic cancer. Although CTHRC1 secretion affects tumor cells, how it promotes tumorigenesis in the context of the microenvironment is largely unknown. Here we identified a novel role of CTHRC1 as a potent endothelial activator that promotes angiogenesis by recruiting bone marrow-derived cells to the tumor microenvironment during tumorigenesis. Recombinant CTHRC1 (rCTHRC1) enhanced endothelial cell (EC) proliferation, migration and capillary-like tube formation, which was consistent with the observed increases in neovascularization in vivo. Moreover, rCTHRC1 upregulated angiopoietin-2 (Ang-2), a Tie2 receptor ligand, through ERK-dependent activation of AP-1 in ECs, resulting in recruitment of Tie2-expressing monocytes (TEMs) to CTHRC1-overexpressing tumor tissues. Treatment with a CTHRC1-neutralizing antibody-abrogated Ang-2 expression in the ECs in vitro. Moreover, administration of a CTHRC1-neutralizing antibody to a xenograft mouse model reduced the tumor burden and infiltration of TEMs in the tumor tissues, indicating that blocking the CTHRC1/Ang-2/TEM axis during angiogenesis inhibits tumorigenesis. Collectively, our findings support the hypothesis that CTHRC1 induction of the Ang-2/Tie2 axis mediates the recruitment of TEMs, which are important for tumorigenesis and can be targeted to achieve effective antitumor responses in pancreatic cancers.

Fatty Acid Content in Perilla Cultivars and Commercial Oils Determined by GC Analysis

The content analysis of fatty acids in Perilla cultivars and commercial oils is conducted through gas chromatography with a flame ionization detector. Results show that Perilla cultivars, such as Deulsaem and Daesil, contain high amounts of α-linolenic acid (262.22 and 261.97 mg/g, respectively). Among commercial oils, Perilla oil contains a higher amount of α-linolenic acid (515.20 mg/g). Accordingly, α-linolenic acid is a major fatty acid of Perilla cultivars and oil. Therefore, Perilla cultivars could be used as a food supplement for nutritional and pharmaceutical purposes.

Effects of Systemic Administration of Dexmedetomidine on Intraocular Pressure and Ocular Perfusion Pressure during Laparoscopic Surgery in a Steep Trendelenburg Position: Prospective, Randomized, Double-Blinded Study

Increased intraocular pressure (IOP) during surgery is a risk factor for postoperative ophthalmological complications. We assessed the efficacy of systemically infused dexmedetomidine in preventing the increase in IOP caused by a steep Trendelenburg position, and evaluated the influence of underlying hypertension on IOP during surgery. Sixty patients undergoing laparoscopic surgery in a steep Trendelenburg position were included. Patients in the dexmedetomidine group received a 1.0 µg/kg IV loading dose of dexmedetomidine before anesthesia, followed by an infusion of 0.5 µg/kg/hr throughout the operation. Patients in the saline group were infused with the same volume of normal saline. IOP and ocular perfusion pressure (OPP) were measured 16 times pre- and intraoperatively. In the saline group, IOP increased in the steep Trendelenburg position, and was 11.3 mmHg higher at the end of the time at the position compared with the baseline value (before anesthetic induction). This increase in IOP was attenuated in the dexmedetomidine group, for which IOP was only 4.2 mmHg higher (P < 0.001 vs. the saline group). The steep Trendelenburg position was associated with a decrease in OPP; the degree of decrease was comparable for both groups. In intragroup comparisons between patients with underlying hypertension and normotensive patients, the values of IOP at every time point were comparable. Dexmedetomidine infusion attenuated the increase in IOP during laparoscopic surgery in a steep Trendelenburg position, without further decreasing the OPP. Systemic hypertension did not seem to be associated with any additional increase in IOP during surgery. (Registration at the Clinical Research Information Service of Korea National Institute of Health ID: KCT0001482)

Severe and persistent hypotension after simultaneous nephrectomy and kidney transplantation in patients with chronic renal failure caused by polycystic kidney disease: Two cases report

Patients with autosomal dominant polycystic kidney disease have significant morbidity due to large kidney size. Surgical extirpation of polycystic kidneys is frequently necessary to treat the morbidity or to obtain intraabdominal space for a graft kidney. Simultaneous bilateral nephrectomy and kidney transplantation are performed in many transplant centers to avoid the complications associated with anephric states such as anemia requiring blood transfusion, osteodystrophy, fluid overload, hyperkalemia, and congestive heart failure. However, the risk of postoperative complications after combined bilateral nephrectomy with kidney transplantation is relatively high, especially for cases in which the polycystic kidneys are huge. Here, we report two cases of severe and persistent hypotension during and after combined surgery which may have been caused by adrenal insufficiency or by sympathetic denervation and splanchnic vasculature decompression after the removal of huge polycystic kidneys.

Quantitative Analysis of the Flavonoid Content in the Leaves of Boehmeria nivea and Related Commercial Products

Content analysis of flavonoids (epicatechin, epicatechin gallate, and rutin) present in the leaves of Boehmeria nivea (originating from Geumsan-myeon, Biin-myeon, Hansan-myeon, and Baeksu-eup) and their commercial products (ramie tteok, ramie songpyeon, ramie bory-tteok, and ramie tea) was conducted by HPLC. The content of epicatechin, epicatechin gallate, and rutin was highest in the leaves of B. nivea from Geumsanmyeon (0.138 mg/g), Baeksu-eup (1.654 mg/g) and Geumsan-myeon (12.205 mg/g), respectively. With respect to commercial products, the content of epicatechin and epicatechin gallate was highest in ramie tea, with concentrations of 1.879 and 1.090 mg/g, respectively. Given these flavonoid concentrations, B. nivea leaf extracts have the potential to be used as additives in natural medicinal products, health supplements, and beverages.

What do we take consideration in the patient who has an unpredicted severe portopulmonary hypertension in liver transplantation?: a case report / 대한마취과학회지

Severe portopulmonary hypertension (PPHT) is considered a contraindication for liver transplantation (LT) because of the associated high mortality and poor prognosis. We report the case of a 57-year-old cirrhotic woman with severe PPHT (mean pulmonary artery pressure [mPAP] > 65 mmHg), who underwent a successful living donor LT. Intra-operative use of inhaled iloprost, milrinone, dobutamine, and postoperative use of inhaled nitric oxide and oral sildenafil failed to lower the pulmonary artery pressure (PAP). The patient responded only to nitroglycerin and drainage of massive ascites. Meticulous intra-operative volume control, which included minimizing blood loss and subsequent transfusion, was carried out. The use of vasopressors, which may have elevated the PAP, was strictly restricted. Intra-operative PAP did not show an increase, and the hemodynamics was maintained within relatively normal range, compared to the preoperative state. The patient was discharged without any complications or related symptoms.

Identification of Dammarane-type Triterpenoid Saponins from the Root of Panax ginseng

The root of Panax ginseng, is a Korea traditional medicine, which is used in both raw and processed forms due to their different pharmacological activities. As part of a continued chemical investigation of ginseng, the focus of this research is on the isolation and identification of compounds from Panax ginseng root by open column chromatography, medium pressure liquid chromatography, semi-preparative-high performance liquid chromatography, Fast atom bombardment mass spectrometric, and nuclear magnetic resonance. Dammarane-type triterpenoid saponins were isolated from Panax ginseng root by open column chromatography, medium pressure liquid chromatography, and semi-preparative-high performance liquid chromatography. Their structures were identified as protopanaxadiol ginsenosides [gypenoside-V (1), ginsenosides-Rb1 (2), -Rb2 (3), -Rb3 (4), -Rc (5), and -Rd (6)], protopanaxatriol ginsenosides [20(S)-notoginsenoside-R2 (7), notoginsenoside-Rt (8), 20(S)-O-glucoginsenoside-Rf (9), 6-O-[alpha-L-rhamnopyranosyl(1-->2)-beta-D-glucopyranosyl]-20-O-beta-D-glucopyranosyl-3beta,12beta, 20(S)-dihydroxy-dammar-25-en-24-one (10), majoroside-F6 (11), pseudoginsenoside-Rt3 (12), ginsenosides-Re (13), -Re5 (14), -Rf (15), -Rg1 (16), -Rg2 (17), and -Rh1 (18), and vinaginsenoside-R15 (19)], and oleanene ginsenosides [calenduloside-B (20) and ginsenoside-Ro (21)] through the interpretation of spectroscopic analysis. The configuration of the sugar linkages in each saponin was established on the basic of chemical and spectroscopic data. Among them, compounds 1, 8, 10, 11, 12, 19, and 20 were isolated for the first time from P. ginseng root.

Non-operative spinal interventions for cervical and lumbar spinal pain

No abstract available.

Preanesthetic management for patients to have surgical procedures

No abstract available.

Combined use of a McGrath(R) MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome: a case report / 대한마취과학회지

Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath(R) MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a different curvature. The Frova Intubating Introducer is used as a railroad for an endotracheal tube in cases of a difficult airway. We thought that a combination of these two devices would make it easy to insert an endotracheal tube through the vocal cords, as a McGrath(R) MAC video laryngoscope provides a better glottic view and the Frova Intubating Introducer is a useful device for placing an endotracheal tube through the glottis. We report a successful endotracheal intubation with use of the McGrath(R) MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome.

Healthcare providers have to be careful with drug abuse in Korea

No abstract available.