Anti-inflammatory, Anti-glycation, Anti-tyrosinase and CDK4 Inhibitory Activities of Alaternin (=7-Hydroxyemodin)

The aim of this study was to anatomize the therapeutic potential of alaternin (=7-hydroxyemodin) against inflammation, advanced glycation end products (AGEs) formation, tyrosinase, and two cyclin-dependent kinases (CDKs), CDK2 and CDK4, and compare its potency with emodin. Alaternin showed lower cytotoxicity and higher dose-dependent inhibition against lipopolysaccharide (LPS) induced nitric oxide (NO) production with half maximal inhibitory concentration (IC 50 ) of 18.68 µM. Similarly, alaternin efficaciously inhibited biotransformation of fluorescent AGEs and amyloid cross-β structure on the bovine serum albumin (BSA)-glucose-fructose system, five times more than emodin. Interestingly, alaternin also showed selective activity against CDK4 at 170 µM, whereas emodin inhibited both CDK2 and CDK4 at a concentration of 17 and 380 µM respectively. In addition, alaternin showed dose-dependent inhibitory activity against mushroom tyrosinase with inhibition percentage of 35.84 % at 400 µM. Altogether, alaternin with pronounced inhibition against inflammatory mediator (NO), glycated products formation, and targeted inhibition towards CDK4 receptor can be taken as an important candidate to target multiple diseases.

Anti-inflammatory, Anti-glycation, Anti-tyrosinase and CDK4 Inhibitory Activities of Alaternin (=7-Hydroxyemodin)

The aim of this study was to anatomize the therapeutic potential of alaternin (=7-hydroxyemodin) against inflammation, advanced glycation end products (AGEs) formation, tyrosinase, and two cyclin-dependent kinases (CDKs), CDK2 and CDK4, and compare its potency with emodin. Alaternin showed lower cytotoxicity and higher dose-dependent inhibition against lipopolysaccharide (LPS) induced nitric oxide (NO) production with half maximal inhibitory concentration (IC 50 ) of 18.68 µM. Similarly, alaternin efficaciously inhibited biotransformation of fluorescent AGEs and amyloid cross-β structure on the bovine serum albumin (BSA)-glucose-fructose system, five times more than emodin. Interestingly, alaternin also showed selective activity against CDK4 at 170 µM, whereas emodin inhibited both CDK2 and CDK4 at a concentration of 17 and 380 µM respectively. In addition, alaternin showed dose-dependent inhibitory activity against mushroom tyrosinase with inhibition percentage of 35.84 % at 400 µM. Altogether, alaternin with pronounced inhibition against inflammatory mediator (NO), glycated products formation, and targeted inhibition towards CDK4 receptor can be taken as an important candidate to target multiple diseases.

Modified Trans-Middle Temporal Gyrus Approach for Trigonal Tumor to Preserve Visual Field

OBJECTIVE: We evaluated a modified trans-middle temporal gyrus (MTG) approach with good postoperative visual preservation for patients with trigonal tumors. METHODS: Three patients with a trigonal tumor were treated via the modified trans-MTG approach guided by a neuro-navigator. Modified trans-MTG approach involve the incision at the MTG within 5 mm to the superior temporal sulcus. This approach makes a proper trajectory to the trigone but also reduces the retraction injury of MTG as little as possible to prevent postoperative visual field defect. Preoperative and postoperative visual field examination using perimetry was performed to evaluate the visual field. RESULTS: Three patients underwent surgery for lymphoma in the right trigone, meningioma in the left trigone, and focal enhancing nodule in the right paratrigonal area, respectively. In case of lymphoma, preoperative examination showed a left homonymous hemianopsia : one week later after surgery, a visual field examination was performed and revealed improvement of the visual field defect. In case of the meningioma, the preoperative examination showed no visual field defect : one month later, the visual field had no defect. In case of the enhancing nodule, preoperative visual field testing revealed a partial left homonymous hemianopsia. Visual examination within one month after surgery showed no visual field defect. All three patients treated with the modified trans-MTG approach showed no visual deterioration after surgery. CONCLUSION: The modified trans-MTG approach provides a safe and useful technique for trigonal tumors without postoperative visual field deterioration and affords adequate exposure of the trigonal tumor with a short trajectory.

Post-Traumatic Cerebral Infarction : Outcome after Decompressive Hemicraniectomy for the Treatment of Traumatic Brain Injury

OBJECTIVE: Posttraumatic cerebral infarction (PTCI), an infarction in well-defined arterial distributions after head trauma, is a known complication in patients with severe head trauma. The primary aims of this study were to evaluate the clinical and radiographic characteristics of PTCI, and to assess the effect on outcome of decompressive hemicraniectomy (DHC) in patients with PTCI. METHODS: We present a retrospective analysis of 20 patients with PTCI who were treated between January 2003 and August 2005. Twelve patients among them showed malignant PTCI, which is defined as PTCI including the territory of Middle Cerebral Artery (MCA). Medical records and radiologic imaging studies of patients were reviewed. RESULTS: Infarction of posterior cerebral artery distribution was the most common site of PTCI. Fourteen patients underwent DHC an average of 16 hours after trauma. The overall mortality rate was 75%. Glasgow outcome scale (GOS) of survivors showed that one patient was remained in a persistent vegetative state, two patients were severely disabled and only two patients were moderately disabled at the time of discharge. Despite aggressive treatments, all patients with malignant PTCI had died. Malignant PTCI was the indicator of poor clinical outcome. Furthermore, Glasgow coma scale (GCS) at the admission was the most valuable prognostic factor. Significant correlation was observed between a GCS less than 5 on admission and high mortality (p<0.05). CONCLUSION: In patients who developed non-malignant PTCI and GCS higher than 5 after head injury, early DHC and duroplasty should be considered, before occurrence of irreversible ischemic brain damage. High mortality rate was observed in patients with malignant PTCI or PTCI with a GCS of 3-5 at the admission. A large prospective randomized controlled study will be required to justify for aggressive treatments including DHC and medical treatment in these patients.

Hemolytic Crisis and Acute Kidney Injury in Patient with Paroxysmal Nocturnal Hemoglobinuria in Korea : Case Report and Review of Literature / 대한신장학회지

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. However, acute kidney injury may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 35-year-old woman, who developed hemolytic crisis and acute kidney injury was admitted to our hospital presenting with acute gastroenteritis. After being treated by hemodialysis and oral low dose steroid, she was discharged with recovered renal function. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition without evidence of vascular thrombosis. A review of Korean cases showed that most of the cases featured severe renal dysfunction to such an extent to require a hemodialysis although there were no definite etiologies other than the deposition of blood iron due to massive hemolysis unlike the foreign cases. It also showed that the disease duration was longer. It can therefore be inferred that the early diagnosis and active treatment will be mandatory for the treatment of Korean patients with PNH. We reported a case of PNH with acute kidney injury and hemolytic crisis and documented by renal biopsy with review of Korean literature.

Clinical Characteristics and Survival Analysis of Elderly Patients Undergoing Continuous Ambulatory Peritoneal Dialysis / 대한신장학회지

PURPOSE: The increased prevalence and incidence of end-stage renal disease in the elderly is a worldwide phenomenon. We investigated the survival rate, technical success, cause of death and the predictors of death in patients starting peritoneal dialysis over 65 years of age. METHODS: We analyzed 67 patients; 37 were in the elderly group (>65 years of age) and 30 in the control group (45-64 years of age) that started peritoneal dialysis between January 1995 and June 2006. Clinical characteristics and laboratory findings at the beginning of dialysis and 6 months later were retrospectively analyzed. In addition, the survival rate and independent predictors of survival were analyzed. RESULTS: The prevalence of complication was not different in the two groups. However, leakage of dialysate was more common in the elderly group. The duration of patient survival, serum albumin levels and BMI were lower in the elderly group. The multivariate analysis showed that age, presence of diabetes, initial albumin level, and residual renal function was associated with patient survival, gender, age, initial albumin level, and the prevalence of peritonitis affected the technical success rate. CONCLUSION: Among elderly patients, leakage was more prevalent compared to the younger patients and the most common cause of death was cardiovascular disease. The presence of diabetes, a low serum albumin and BMI, and residual renal function were associated with the duration of survival

Relationship between serum brain natriuretic peptide and heart function in patients with chronic kidney disease

BACKGROUND/AIMS: Brain natriuretic peptide (BNP) levels are known to be elevated in patients with chronic kidney disease (CKD) and normal heart function. Therefore, the present study was performed to examine the effectiveness of BNP level in diagnosing heart failure in patients with CKD and to determine its effects on survival rate and prognosis. METHODS: A total of 182 patients with CKD who visited the hospital due to dyspnea of NYHA class II were included in the study. BNP levels were measured and echocardiography was performed to divide the subjects into groups with and without heart failure. Their BNP levels, clinical courses, and survival rates were analyzed retrospectively. RESULTS: When BNP level was > or =858.5 pg/mL in CKD patients, heart failure could be diagnosed with sensitivity and specificity of 77% and 72%, respectively. Survival rate of the group with BNP levels of > or =858.8 pg/mL was significantly lower than that of the group with BNP level below this threshold (p=0.012) and multivariate analysis showed that BNP level, age, and sex affected survival rate in the group with BNP level > or =858.8 pg/mL. CONCLUSIONS: BNP levels of patients with CKD showed a positive correlation with creatinine levels, and the critical point of BNP level for diagnosis of heart failure was 858.5 pg/mL. As the survival rate in patients with BNP level above the critical point was significantly low, this level was a useful indicator for predicting their prognosis. Care should be taken in interpreting BNP level because patients with stage 5 CKD may show a high concentration of BNP without heart failure.

Effect of Temporary Clipping on the Cerebral Infarction in Middle Cerebral Artery Aneurysm Surgery / 대한뇌혈관외과학회지

OBJECTIVE: This study evaluated the effects of temporary clipping on an infarction after middle cerebral artery aneurysmal surgery. METHODS: Three hundreds and seventeen patients with a middle cerebral artery aneurysm were treated surgically at our department. Among them, the patients who had an intracerebral hematoma or a cerebral infarction prior to surgery or poor clinical mental state (Hunt and Hess grade V) on admission were excluded from the analysis. Two hundreds and twenty nine patients were selected in this study. An acute cerebral infarction, which had no any evidence of retraction injury or vasospasm and occurred on the same side of the surgical site within 3 days after the operation, was regarded as the cerebral infarction as a result of the temporary clipping. RESULTS: Twenty out of 229 patients (8.7%) developed a new acute cerebral infarction after surgery. The causes of the infarction were as follows: 13 patients related to the temporary clipping, 5 patients to the vasospasm and 2 patients to the brain retraction injury. The incidence of an acute cerebral infarction according to the frequency of temporary clippings was 5.5% (3 of 55 patients) of those who underwent a single temporary clipping, 6.7% (4 of 60 patients) of those who underwent two or three temporary clipping and 20.7% (6 of 29 patients) of those who underwent more than 4 temporary clippings. The incidence of an acute cerebral infarction was significantly higher when the temporary clip had been applied more than 4 times (P<0.021). However, the clipping time didn't show statistically significance. CONCLUSION: The incidence of acute cerebral infarction after a surgery for a middle cerebral artery aneurysm was related to the frequency of temporary clippings during surgery. It was significantly higher in the cases where more than 4 temporary clipping had been applied.

Clinical Characteristics of Alcoholic Ketoacidosis in Patients with Chronic Alcoholic Ingestion / 대한신장학회잡지

BACKGROUND:Alcoholic ketoacidosis is a common disorder observed in chronic alcoholics with metabolic acidosis but there were only several reports. This study was undertaken to evaluate the clinical characteristics of alcoholic ketoacidosis and to identify prognostic factors that could affect survival of patients. METHODS:We retrospectively evaluated the clinical characteristics and prognostic factors in 66 patients who were diagnosed with alcoholic ketoacidosis. RESULTS: There were 57 men and 9 women and their mean age was 48.6 years. Duration of alcohol intake was 20+/-12 years. The amount of daily alcohol intake was 129+/-68 g. Alcohol drinking patterns such as duration and the amount of daily alcohol consumption did not differ significantly between the non-survivors the and survivors. On laboratory testing, the levels of creatinine, pCO2, leukocyte count, total bilirubin, creatinine, creatine kinase and lactate dehydrogenase were significantly higher in the non-survivors than in the survivors (respectively, p=0.044; p=0.003; p=0.001; p=0.011; p=0.007; p=0.018). The levels of hemoglobin, total protein, albumin and calcium were significantly lower in the non-survivors than in the survivors (respectively, p=0.003; p=0.022; p=0.001; p= 0.001). Combined conditions on admission were acute renal failure (36/66), alcoholic hepatitis (29/66), gastritis (21/66), rhabdomyolysis (15/66), alcohol withdrawal syndrome (15/66), infections (15/66) and pancreatitis (10/66). Mortality rate was 22.7% (15/66) and common causes of death were uncontrolled acidosis, sepsis and gastrointestinal bleeding. CONCLUSION: The general conditions, ability of respiratory compensation, renal function and the severity of liver disease on admission were associated with mortality in patients with alcoholic ketoacidosis.

Middle Cerebral Artery Variations Associated with Intracranial Aneurysmal Rupture

Aneurysmal ruptures associated with middle cerebral artery(MCA) anomalies, such as a duplicated MCA and an accessory MCA, are quite rare. The authors reviewed the clinical relevance and possible etiology of these anomalies.

Bilateral Simultaneous Hypertensive Intracerebral Hemorrhages in Both Thalami

The recurrent intracerebral hemorrhage(ICH) in hypertensive patients is not an unusual event, but the simultaneous occurrence of multiple ICH is rare. A 70-year-old woman presented with bilateral simultaneous hypertensive intracerebral hemorrhages in both thalami. The complaints of the patient were unconsciousness (semicomatose mental state) and quadriparesis Grade II. The patient was managed conservatively. At discharge, the patient was awake (drowsy mental state), but Grade III according to the Glasgow Outcome Score. This paper reviews the clinical relevance, possible etiology, and treatment of bilateral thalamic ICH.