Multiple Injections of Adipose-Derived Stem Cells Improve Graft Survival in Human-to-Rat Skin Xenotransplantation through Immune Modulation

BACKGROUND@#Adipose-derived stem cells (ADSCs) exert immunomodulatory effects in the treatment of transplant rejection. This study aimed to evaluate the effects of ADSCs on the skin graft survival in a human-to-rat xenograft transplantation model and to compare single and multiple injections of ADSCs. @*METHODS@#Full-thickness human skin xenografts were transplanted into the backs of Sprague–Dawley rats. The rats were injected subcutaneously on postoperative days 0, 3, and 5. The injections were as follows: triple injections of phosphate-buffered saline (PBS group), a single injection of ADSCs and double injections of PBS (ADSC 9 1 group), and triple injections of ADSCs (ADSC 9 3 group). The immunomodulatory effects of ADSCs on human skin xenografts were assessed. @*RESULTS@#Triple injections of ADSCs considerably delayed cell-mediated xenograft rejection compared with the PBS and ADSC 9 1 groups. The vascularization and collagen type 1–3 ratios in the ADSC 9 3 group were significantly higher than those in the other groups. In addition, intragraft infiltration of CD3-, CD4-, CD8-, and CD68-positive cells was reduced in the ADSC 9 3 group. Furthermore, in the ADSC 9 3 group, the expression levels of proinflammatory cytokine interferon-gamma (IFN-c) were decreased and immunosuppressive prostaglandin E synthase (PGES) was increased in the xenograft and lymph node samples. @*CONCLUSION@#This study presented that triple injections of ADSCs appeared to be superior to a single injection in suppressing cell-mediated xenograft rejection. The immunomodulatory effects of ADSCs are associated with the downregulation of IFN-c and upregulation of PGES in skin xenografts and lymph nodes.

The Lived Experiences of Patient’s Families with the Intensive Care Unit Diary / 중환자간호학회지

Purpose@#: Intensive care unit (ICU) diaries have been implemented across the international ICU community. This study aimed to comprehend the meaning and nature of the lived experience of patients’ families using the ICU diary in Korea. @*Methods@#: This qualitative study adopted van Manen’s hermeneutic phenomenology. The participants comprised eight women and two men who were the family members of patients in the ICU for more than three days. Data were collected using in-depth interviews and observation from July 2018 to January 2019. @*Results@#: Patients’ families who experienced the ICU diary recognized it with six beings according to time: a good idea, forgotten stuff, burdensome work, touching service, my stuff, and a thing in the memory. The ICU diary had three essential meanings for the families: communication, solace and hope, and a record of life. These findings were rearranged according to van Manen’s fundamental existential, and the lived things and lived others were remarkably confirmed. @*Conclusion@#: Patients’ families experienced various ICU diary forms over time and recognized an ICU diary as a means of communication. Therefore, the ICU diary is expected to be used as an intervention between families and healthcare providers in the ICU to support mutual communication.

Evaluation of Clinical Alarms and Alarm Management in Intensive Care Units

PURPOSE: This study aimed to investigate the clinical alarm occurrence and management of nurses toward clinical alarms in the intensive care unit (ICU). METHODS: This observational study was conducted with 40 patients and nurses cases in two ICUs of a university hospital. This study divided 24 hours into the unit of an hour and conducted two times of direct observation per unit hour for 48 hours targeting the medical devices applied to 40 patients. Data were analyzed using IBM SPSS Statistics 23. RESULTS: On average, 3.8 units of medical devices were applied for each patient and the ranges of alarm settings were wide. During 48 hours, 184 cases of clinical alarm were occurred by four types of medical devices including physiological monitors, mechanical ventilators, infusion pumps, and continuous renal replacement therapy. Among them, false alarm was 110 cases (59.8%). As for the alarm management by ICU nurses, two-minute alarm mute took up most at 38.0% (70 cases), and no response was second most at 32.6% (60 cases). When valid alarm sounded, nurses showed no response at 43.2%. CONCLUSION: The findings suggest that a standard protocol for alarm management should be developed for Korean ICU settings. Based on the protocol, continuous training and education should be provided to nurses for appropriate alarm management.

Correlation of Executive Function and Quantitative Electroencephalography in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder / 정신신체의학

OBJECTIVES: Attention-deficit hyperactivity disorder(ADHD) is characterized by significant impairments in executive functions, with a prevalence of approximately 3-5% of all children worldwide. The goal of this study was to examine the relationship between executive functions and electrophysiological activities in children and adolescents with ADHD. METHODS: In 31 patients with ADHD, resting-state EEG was recorded, and Comprehensive Attention Test(CAT), Stroop Color-Word Inference Test(Stroop CWIT), Trail Making Test(TMT), and Wisconsin Card Sorting Test(CST) were administered. Korean version of the ADHD Rating Scale(K-ARS) was assessed. RESULTS: Alpha and beta power positively correlated with the Attention Quotient(AQ), while delta power negatively correlated with AQ from CAT. In the Stroop CWIT, decreased delta power and increased beta power were related to higher performance. Power of the alpha band increased with higher TMT performance. Moreover, delta power negatively correlated with good performance on the CST, while alpha and high gamma band showed a positive correlation. Correlation with the parent-rating of ADHD symptoms showed a negative correlation between alpha power and higher scores on the K-ARS. CONCLUSIONS: These findings indicate that relative power in higher frequency bands of EEG is related to the higher executive function in children and adolescents with ADHD, while the association with the relative power in lower frequency bands of EEG seem to be vice versa. Furthermore, the findings suggest that QEEG may be a useful adjunctive tool in assessing patients with ADHD.

Withaferin A Inhibits Helicobacter pylori-induced Production of IL-1beta in Dendritic Cells by Regulating NF-kappaB and NLRP3 Inflammasome Activation

Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer, and gastric cancer. There is evidence that IL-1beta is associated with the development of gastric cancer. Therefore, downregulation of H. pylori-mediated IL-1beta production may be a way to prevent gastric cancer. Withaferin A (WA), a withanolide purified from Withania somnifera, is known to exert anti-inflammatory and anti-tumor effects. In the present study, we explored the inhibitory activity of WA on H. pylori-induced production of IL-1beta in murine bone marrow-derived dendritic cells (BMDCs) and the underlying cellular mechanism. Co-treatment with WA decreased IL-1beta production by H. pylori in BMDCs in a dose-dependent manner. H. pylori-induced gene expression of IL-1beta and NLRP3 (NOD-like receptor family, pyrin domain containing 3) were also suppressed by WA treatment. Moreover, IkappaB-alpha phosphorylation by H. pylori infection was suppressed by WA in BMDCs. Western blot analysis revealed that H. pylori induced cleavage of caspase-1 and IL-1beta, as well as increased procaspase-1 and pro IL-1beta protein levels, and that both were suppressed by co-treatment with WA. Finally, we determined whether WA can directly inhibit ac tivation of the NLRP3 inflammasome. NLRP3 activators induced IL-1beta secretion in LPS-primed macrophages, which was inhibited by WA in a dose-dependent manner, whereas IL-6 production was not affected by WA. Moreover, cleavage of IL-1beta and caspase-1 by NLRP3 activators was also dose-dependently inhibited by WA. These findings suggest that WA can inhibit IL-1beta production by H. pylori in dendritic cells and can be used as a new preventive and therapeutic agent for gastric cancer.

Theory of Mind as a Mediator of Reasoning and Facial Emotion Recognition: Findings from 200 Healthy People

OBJECTIVE: It was proposed that the ability to recognize facial emotions is closely related to complex neurocognitive processes and/or skills related to theory of mind (ToM). This study examines whether ToM skills mediate the relationship between higher neurocognitive functions, such as reasoning ability, and facial emotion recognition. METHODS: A total of 200 healthy subjects (101 males, 99 females) were recruited. Facial emotion recognition was measured through the use of 64 facial emotional stimuli that were selected from photographs from the Korean Facial Expressions of Emotion (KOFEE). Participants were requested to complete the Theory of Mind Picture Stories task and Standard Progressive Matrices (SPM). RESULTS: Multiple regression analysis showed that the SPM score (t=3.19, p=0.002, beta=0.22) and the overall ToM score (t=2.56, p=0.011, beta=0.18) were primarily associated with a total hit rate (%) of the emotion recognition task. Hierarchical regression analysis through a three-step mediation model showed that ToM may partially mediate the relationship between SPM and performance on facial emotion recognition. CONCLUSION: These findings imply that higher neurocognitive functioning, inclusive of reasoning, may not only directly contribute towards facial emotion recognition but also influence ToM, which in turn, influences facial emotion recognition. These findings are particularly true for healthy young people.

The relationship between perioperative nausea and vomiting and serum serotonin concentrations in patients undergoing cesarean section under epidural anesthesia / 대한마취과학회지

BACKGROUND: Serotonin-also known as 5-hydroxytryptamine or 5-HT-can induce nausea and vomiting (NV) by peripheral mechanisms via the activation of 5-HT3 receptors. In this study, we observed perioperative NV, including intraoperative NV, and changes in serum 5-HT concentrations. We evaluated the relationship between perioperative NV and serum 5-HT levels in patients undergoing cesarean section under epidural anesthesia, and carried out a pilot study to determine if further studies on a larger scale were justified. METHODS: Twenty-eight patients who were scheduled for cesarean section under epidural anesthesia were included in the study. Patients were assigned to 2 groups according to the occurrence of NV after induction, i.e., an NV-positive or an NV-negative group. Serum 5-HT concentrations were measured before induction, at the time that NV occurred (in the case of the NV-positive group) or 5 min after the umbilical cord clamping (in the case of the NV-negative group) during surgery, and at 2 h postoperatively. RESULTS: NV occurred in 10 of the 28 patients. No significant differences in serum 5-HT concentrations were found within or between the two groups. CONCLUSIONS: This study suggests that there is no correlation between serum 5-HT concentration and the occurrence of perioperative NV in patients undergoing cesarean section under epidural anesthesia, and the findings do not seem to support further investigations regarding a possible relationship between serum 5-HT concentration and perioperative NV.

Attributional Style in Healthy Persons: Its Association with 'Theory of Mind' Skills

OBJECTIVE: Attributional style, especially external personal attribution bias, was found to play a pivotal role in clinical and non-clinical paranoia. The study of the relationship of the tendency to infer/perceive hostility and blame with theory of mind skills has significant theoretical importance as it may provide additional information on how persons process social situations. The aim of this study was whether hostility perception bias and blame bias might be associated with theory of mind skills, neurocognition and emotional factors in healthy persons. METHODS: Total 263 participants (133 male and 130 female) were recruited. The attributional style was measured by using the Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were requested to complete a Brune's Theory of Mind Picture Stories task, neurocognitive task including Standard Progressive Matrices (SPM) and digit span, and other emotional dysregulation trait scales including Rosenberg's self-esteem, Spielberg's trait anxiety inventory, and Novaco anger scale. RESULTS: Multiple regression analysis showed that hostility perception bias score in ambiguous situation were found to be associated with theory of mind questionnaire score and emotional dysregulation traits of Novaco anger scale. Also, composite blame bias score in ambiguous situation were found to be associated with emotional dysregulation traits of Novaco anger scale and Spielberg's trait anxiety scale. CONCLUSION: The main finding was that the attributional style of hostility perception bias might be primarily contributed by theory of mind skills rather than neurocognitive function such as attention and working memory, and reasoning ability. The interpretations and implications would be discussed in details.

Paroxysmal atrial fibrillation developed during perioperative periods in an adolescent without any underlying disease: A case report

Although the development of arrhythmias including atrial fibrillation (AF) is common under general anesthesia during surgery, the first episode of AF to occur during this period is rather uncommon. Moreover, most instances of AF are associated with old age, cardiopulmonary diseases as well as metabolic, endocrine, or genetic abnormalities. The occurrence of paroxysmal AF in the perioperative period in an adolescent without any underlying diseases or organic abnormalities has never been reported. Herein, we report a case of a 16-year-old adolescent whose paroxysmal AF was suspected before the anesthesia induction for strabismus surgery and diagnosed after anesthetic induction. Nevertheless, he was managed successfully with esmolol infusions during and after the surgery and thus recovered spontaneously.

A Case of Sweet's Syndrome Presenting as Subdermal Cystic Lesions and Arthritis / 대한내과학회지

Sweet's syndrome is characterized by a combination of clinical and pathologic findings including fever, neutrophilia, tender erythematous skin lesions, and a diffuse infiltration of mature neutrophils in the upper dermis. Numerous diseases and clinical manifestations have been associated with the disease; however, Sweet's syndrome associated with subdermal cystic skin lesions and arthritis is rare. A 71-year-old female patient presented with fever, erythematous plaques, multiple hypoglossal ulcers, and arthritis in both ankles. The skin lesions were variously sized areas of erythematous swelling on the forehead, back, and left shoulder. Musculoskeletal sonography revealed hypervascularity and a subdermal cyst in the erythematous plaque on her back. The results of a skin biopsy indicated the presence of mature neutrophilic infiltration in the dermis and thus led to the diagnosis of Sweet's syndrome. We herein present an unusual case of Sweet's syndrome presenting as erythematous subdermal cystic lesions, multiple hypoglossal ulcers, and bilateral ankle arthritis with a literature review.

A Case of Wegener's Granulomatosis Presenting as a Diplopia

Wegener's granulomatosis (WG) is a multisystemic granulomatous inflammatory disorder which is presumably caused by an autoimmune response. It typically targets the upper and lower respiratory tract and the kidney. Ocular involvement occurs in 50 to 60% of WG patients. However, orbital myositis and diplopia as a presenting symptom is a rare ocular manifestation. We present the case of a 49-year-old man who was admitted with bilateral diplopia due to orbital myositis under a diagnosis of WG. He was successfully treated with high dose corticosteroid therapy.

A Case of Sensorimotor Polyneuropathy in a Patient with Sjogren's Syndrome / 대한내과학회지

Sjogren's syndrome is a chronic inflammatory disorder characterized by lymphocytic infiltration of the exocrine glands, especially the lacrimal and salivary glands. Although it is characterized primarily by a particular form of dry eyes (keratoconjunctivitis sicca) and a dry mouth (xerostomia), this condition may affect a wide variety of organ systems, including the skin, lungs, heart, and kidneys, and it may rarely have neurological manifestations. The peripheral neuropathy results from nerve damage due to vasculitis or nerve sheath demyelination, which adversely affects the ability of nerves to send messages. We report the case of a 71-year-old woman who presented with polyneuropathy of the lower limbs that was diagnosed as Sjogren's syndrome but progressed to muscle atrophy during her treatment.

A Case of Ankylosing Spondylitis Associated with Turner's Syndrome

Turner's syndrome (TS) is a chromosomal disorder where phenotypic females have either a missing chromosome (45 XO) or a structural aberration in one of the chromosomes. Previous studies have suggested that women with TS may be at increased risk of several autoimmune diseases, such as Hashimoto thyroiditis, celiac disease, Crohn's disease, ulcerative colitis, juvenile rheumatoid arthritis, and vitiligo. Although a high risk has been documented for autoimmune diseases in TS, there is only one case reporting the relationship between TS and ankylosing spondylitis (AS) in the literature. Herein, we present an unusual case of AS associated with TS.

Effects of Antiplatelet Agents on the Graft Survival in Murine Cardiac and Skin Transplantation Model / 대한이식학회지

BACKGROUND: At the initiation of immunologic response, platelets rapidly release chemical mediators which may induce rejection of transplanted organ. The purpose of this study was to investigate the effect of antiplatelet agents in murine cardiac and skin transplantation models. METHODS: In the minor major histocompatibility (MHC) mismatch model, BALB/c (H2d) mice underwent heart transplantation from B10.D2 (H2d) mice. In the major MHC mismatch model, CBA (H2k) mice were used as the recipients and C57BL/10 (H2b) mice as donors. The recipients were divided into four groups and each group was treated with distilled water (DW), sarpogrelate, cilostazol, or clopidogrel respectively. For skin transplantation, the recipients in the minor MHC mismatch model were divided into four groups similar to those in cardiac transplantation. The recipients in the major MHC mismatch model were divided into DW-treated and sarpogrelate-treated groups. All treatments were done by the per oral route of administration. RESULTS: For graft survival in the minor MHC mismatch model of cardiac transplantation, sarpogrelate-treated group showed increased median survival time (MST) compared to the other groups (DW-treated group 17.5 days, sarpogrelate-treated group 88 days, cilostazol-treated group 13 days, clopidogrel-treated group 23 days). Similar results were observed in the major MHC mismatch model. In the major MHC mismatch model, the expression of adhesion molecules (L-selectin, intercellular adhesion molecule-1 [ICAM-1], Mac-1, lymphocyte function associated antigen-1 [LFA-1]) was significantly higher in DW-treated group compared to sarpogrelate-treated group (P<0.05) In the minor MHC mismatch model, MST in the antiplatelet-treated skin graft group was not remarkably prolonged compared to DW-treated group. In the major MHC mismatch model, sarpogrelate-treated group showed prolonged survival compared to DW-treated group (MST 25 vs. 19 days, P<0.05). There was no statistically significant difference in the proportion of activated T cells and regulatory T cells. CONCLUSIONS: The tendency for a better survival of grafts was observed in the sarpogrelate-treated skin and heart transplant group compared to DW-treated group. However, further mechanistic study is necessary to these results.

A Case of Non Secretory Type Multiple Myeloma Associated with Systemic Lupus Erythematosus / 대한류마티스학회지

The development of malignant tumors is a more frequent finding in lupus patients than the general population. However, the incidence of multiple myeloma associated with systemic lupus erythematosus (SLE) is a rare manifestation. SLE is an autoimmune disease characterized by B cell hyperactivity, formation of autoantibodies, and multi-clonal hypergammaglobulinemia. Serum immunoglobulin increases, with a specific increase in IgG, which is due to an increase in autoantibody formation related to extrinsic and intrinsic antigens. We report on a patient with SLE combined with IgG, lambda type nonsecretory multiple myeloma, which was diagnosed with refractory anemia and hypergammaglobulinemia.

A case of peripheral T-cell lymphoma presenting with a necrotizing gingival ulcer / 대한내과학회지

Peripheral T-cell lymphoma (PTCL) is a heterogenous group of generally aggressive neoplasms constituting less than 15% of all non-Hodgkin's lymphomas in adults. PTCL unspecified (PTCL-U) comprises 6% of lymphomas in the United States and Europe. Most patients with PTCL-U present with generalized lymphadenopathy and hemophagocytosis, eosinophilia, and pruritus involving the skin, liver, spleen, and other viscera. Gingival and genital ulcers are a very uncommon manifestation. The diagnosis of PTCL-U is based on the results of a tissue biopsy that shows evidence of T-cell lymphoma that does not meet the criteria for other subtypes of T-cell lymphoma. Here, we describe an 85-year-old man with intermittent fever and necrotizing gingival and genital ulcers who was diagnosed with PTCL-U after a gingival biopsy.

Association between Nutrient Intakes and Benign Prostate Hyperplasia

Benign prostatic hyperplasia (BPH) is the most common prostate disease in middle aged and elderly men. Therefore, identifying risk factors for BPH is crucial for understanding the etiology and for undertaking interventions or targeting strategies. The survey was carried out in two steps: first, pilot study was conducted prior to the main study in order to estimate baseline characteristics. Second, main study investigated prevalence and risk factors of BPH by clinical diagnostic tests and questionnaire. A total of 641 male aged 50-79 years participated in this community-based crosssectional study. Using 24 hour recall of food consumption, we found that animal fat intakes increased the risk of BPH with adjusted for age, chronic bronchitis, PSA level, drinking frequency, and excercise frequency (odds ratio 1.84, 95% confidence interval 1.10-3.06). Although BPH has been considered as unavoidable disease with advancing age, if these dietary risk factors are clearly identified, it can be prevented effectively by laying special emphasis on those at risk.

Color stability of ceromers in three food colorants / 대한치과보철학회지

STATEMENT OF PROBLEM: Ceramic and composite resin have been used to fulfill the demand for esthetic prosthesis. However, ceramic is easy to break and wears off the opposite natural teeth. Conventional composite resin also has low abrasive resistance and color stability. Ceramic Optimized Polymer (ceromer) was developed in mid-1990s to overcome the shortfalls of ceramic and composite resin. Ceromer has similar abrasiveness with the natural tooth and has relatively high strength. Color stability affects esthetics and long-term prognosis of the prosthesis. PURPOSE: The purpose of this study was to compare color stability of ceromers(2 types : Artglass., Targis.) with ceramics(Vintage.-polishing, Vintage.-glazing). MATERIAL AND METHOD: The color difference(E*) was measured by spectrophotometer with different immersion time. Twenty disks, 3mm in thickness and 10mm in diameter, were fabricated for each specimen in shade A2(Vita Lumin shade guide). Specimens(5 samples in each group) were immersed in the food colorants(Red no.3, Yellow no.4, Blue no.1, Distilled water) for 24 hours, 48 hours and 72 hours respectively. L*, a* and b* value were measured with spectrophotometer (CM 503i : Minolta Co., Japan) and mean E* value was calculated for statistical analysis. RESULTS: The results of this study were obtained as follows. 1. The E* values of all test samples increased with the time of immersion. 2. The E* values of all materials increased in order of Distilled Water, Yellow no.4, Blue no.1 and Red no.3. There was significant difference between Red no.3 and the other food colorants(p<0.05). 3. The E* values increased in order of Vintage-glazing, Vintage-polishing, Artglass and Targis. There was significant difference between Vintage.-glazing and the other materials (p<0.05). CONCLUSION: By means of the above results, immersion time was found to be a critical factor for color stability of ceromer. For the long-term color stability of prosthesis it is recommended patients having ceromer prosthesis(Artglass., Targis.) to reduce the habitual intake of Red no.3 colorants con taining foods.