Radioiodine Therapy of Liver Cancer Cell Following Tissue Specific Sodium Iodide Symporter Gene Transfer and Assessment of Therapeutic Efficacy with Optical Imaging / 핵의학분자영상

PURPOSE: Cancer specific killing can be achieved by therapeutic gene activated by cancer specific promotor. Expression of sodium iodide symporter (NIS) gene causes transportation and concentration ofiodide into the cell, therefore radioiodine treatment after NIS gene transfer to cancer cell could be a form of radionuclide gene therapy. luciferase (Luc) gene transfected cancer cell can be monitored by in vivo optical imaging after D-luciferin injection. Aims of the study are to make vector with both therapeutic NIS gene driven by AFP promoter and reporter Luc gene driven by CMV promoter, to perform hepatocellular carcinoma specific radiodiodine gene therapy by the vector, and assessment of the therapy effect by optical imaging using luciferase expression. MATERIALS AND METHODS: A Vector with AFP promoter driven NIS gene and CMV promoter driven Luc gene (AFP-NIS-CMV-Luc) was constructed. Liver cancer cell (HepG2, Huh-7) and non liver cancer cell (HCT-15) were transfected with the vector using liposome. Expression of the NIS gene at mRNA level was elucidated by RT-PCR. Radioiodide uptake, perchlorate blockade, and washout tests were performed and bioluminescence also measured by luminometer in these cells. In vitro clonogenic assay with I-131 was performed. In vivo nuclear imaging was obtained with gamma camera after I-131 intraperitoneal injection. RESULTS: A Vector with AFP-NIS-CMV-Luc was constructed and successfully transfected into HepG2, Huh-7 and HCT-15 cells. HepG2 and Huh-7 cells with AFP-NIS-CMV-Luc gene showed higher iodide uptake than non transfected cells and the higher iodide uptake was totally blocked by addition of perchlorate. HCT-15 cell did not showed any change of iodide uptake by the gene transfection. Transfected cells had higher light output than control cells. In vitro clonogenic assay, transfected HepG2 and Huh-7 cells showed lower colony count than non transfected HepG2 and Huh-7 cells, but transfected HCT-15 cell did not showed any difference than non transfected HCT-15 cell. Number of Huh-7 cells with AFP-NIS-CMV-Luc gene transfection was positively correlated with radioidine accumulation and luciferase activity. In vivo nuclear imaging with I-131 was successful in AFP-NIS-CMV-Luc gene transfected Huh-7 cell xenograft on nude mouse. CONCLUSION: A Vector with AFP promoter driven NIS and CMV promoter driven Luc gene was constructed. Transfection of the vector showed liver cancer cell specific enhancement of I-131 cytotoxicity by AFP promoter, and the effect of the radioiodine therapy can be successfully assessed by non-invasive luminescence measurement.

The Success Rate of Superior Approach Glenohumeral Injection in Patients with Frozen Shoulder

OBJECTIVE: In treating patients with frozen shoulder, posterior and anterior approach glenohumeral injections are well known methods. But the accuracy of the above injection methods is low. In this study, we introduce the superior approach glenohumeral injection method and evaluate its success rate. METHOD: Twenty six patients who were clinically diagnosed with frozen shoulder were enrolled. Patients received a superior approach glenohumeral injection of 1 cc radiographic contrast (Urografin(R), Schering, Germany). The success of superior approach was determined by radiography study of the shoulder joint taken after the injection. RESULTS: 24 of the 26 procedures (92.3%) were judged to be accurately placed by the radiography study and there was no significant complication after the superior approach intrarticular injection. CONCLUSION: Superior approach glenohumeral injection in frozen shoulder showed the high success rate. We consider this superior approach as a very effective method. If the study for the interrater reliability is added, the superior approach will be considered to be a useful approach.

Gabapentin Induced Liver Injury : A case report

Gabapentin has been accepted worldwide as a novel antiepileptic drug with a favourable tolerability profile. Although its exact mode of action is not known, it is recently widely used to manage symptomatic treatment of neuropathic pain syndromes. It has few side effect profiles and it is known not to be associated with liver injury. But we experienced a case of liver injury associated with gabapentin. A 44-year-old man was hospitalized because of seizure caused by septic shock. He complained of tingling sensation and burning pain on his both legs. Gabapentin was prescribed to control his symptoms. An increase of serum aminotransferases was detected after gabapentin therapy, and immediately after stopping it, aminotransferase level normalized.

The validity and reliability of self-interviewing skills evaluation protocol for residents in family medcine

BACKGROUND: Medical interviewing skills are now recognized as the most important skill to be acquired for the purpose of accurate diagnosis and treatment. Among the several evaluation methods of interviewing skills, audiovisual method has the merit of allowing the fellow residents to have discussion about the interview and of receiving feedback from the teaching faculty by replaying the real interview. In addition, it allows the resident to evaluate his or her interviewing skills, The purpose of this study is to evaluate the reliability and the validity of family residents' self-interviewing skill evaluation protocol. METHODS: A modified arizona interview rating scale which is an interviewing skill evaluating protocol has been used after Korean version became available. Six interviews with outpatients were recorded and evaluated respectively by 10 residents. The results were compared with that of Golden Standard to assess its validity. Finally, 10 residents were divided into two groups and the results among the groups were compared to evaluate the reliability of the scale. RESULTS: The evaluation of interviewing skills conducted by the residents showed significant rate of correspondence with the Golden Standard(kappa=.22), and in the comparison of 17 evaluation items, there appeared significant correspondence in 7 items. The analysis of the rate of correspondence between the two group of residents revealed significant rate of correspondence (kappa=0.43). Lastly, the comparisons between the items showed significant rate of correspondence in ll items CONCLUSIONS: The residents' self interviewing skill evaluation protocol showed significant validity and reliability from which it may be concluded that the protocol can be used as an effective evaluating method.