Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial

Purpose@#This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention. @*Methods@#One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention). @*Results@#Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374). @*Conclusion@#Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

Anal Gland/Duct Cyst: A Case Report

Anal gland/duct cyst (AGC) is rare and observed in only 0.05% of patients undergoing anal surgery. AGC is thought to be a retention cyst in the anal gland and arises when an obstruction of the anal duct causes fluid collection in the anal gland. We report a case of AGC in a 66-year-old woman without anal symptoms. Found by colonoscopy, the AGC was excised transanally. The histopathology of the specimen confirmed AGC. Colonoscopists should include AGC in the differential diagnosis of anal canal mass and rule out of malignancy. Excision is recommended for definitive diagnosis and treatment.

Hidradenoma Papilliferum of the Anus: A Report of 2 Cases and Review of the Literature

Hidradenoma papilliferum is a rare benign cystic tumor that originates from apocrine glands or anogenital mammary glands. Here, we describe 2 cases of hidradenoma papilliferum of the anus. Two female patients aged 39 and 35 presented with perianal masses with hemorrhoids. The patients underwent hemorrhoidectomy and excision of the lesion. Histopathology confirmed the masses as hidradenoma papilliferum. The postoperative course was uneventful for both patients, and there were no recurrences after 18 and 12 months of follow-up, respectively. Proctologists should consider hidradenoma papilliferum in their differential diagnosis of benign anal tumors. Surgical excision is necessary for diagnosis and treatment of hidradenoma papilliferum.

Immunomodulatory Effects of Placenta-derived Mesenchymal Stem Cells on T Cells by Regulation of FoxP3 Expression

The immunomodulatory effects of mesenchymal stem cells (MSCs) are an important mediator of their therapeutic effects in stem cell therapy and regenerative medicine. The regulation mechanism of MSCs is orchestrated by several factors in both intrinsic and extrinsic events. Recent studies have shown that the dynamic expression of cytokines secreted from MSCs control T cell function and maturation by regulating the expression of FoxP3, which figures prominently in T cell differentiation. However, there is no evidence that placenta-derived mesenchymal stem cells (PD-MSCs) have strong immunomodulatory effects on T cell function and maturation via FoxP3 expression. Therefore, we compared the expression of FoxP3 in activated T cells isolated from peripheral blood and co-cultured with PD-MSCs or bone marrow-derived mesenchymal stem cells (BM-MSCs) and analyzed their effect on T cell proliferation and cytokine profiles. Additionally, we verified the immunomodulatory function of PD-MSCs by siRNA-mediated silencing of FoxP3. MSCs, including PD-MSCs and BM-MSCs, promoted differentiation of naive peripheral blood T cells into CD4+CD25+FoxP3+ regulatory T (Treg) cells. Intriguingly, the population of CD4+CD25+FoxP3+ Treg cells co-cultured with PD-MSCs was significantly expanded in comparison to those co-cultured with BM-MSCs or WI38 cells (p < 0.05, p < 0.001). Dynamic expression patterns of several cytokines, including anti- and pro-inflammatory cytokines and members of the transforming growth factor-beta (TGF-β) family secreted from PD-MSCs according to FoxP3 expression were observed. The results suggest that PD-MSCs have an immunomodulatory effect on T cells by regulating FoxP3 expression.

Intranasal Administration Model for Evaluating Protection Against Influenza Virus in Mice

Antiviral activity against Influenza virus of 14 Lactobacillus species isolated from food was monitored. Lactobacillus species were isolated from traditional Korean fermented food. Each live Lactobacillus was administered into the nasal cavity of SPF 6-week-old BALB/c mice. After the Lactobacillus treatment, Influenza virus (A/NWS/33/H1N1) was inoculated to each mouse. Clinical signs and mortality was monitored for 21 days. Each Lactobacillus strain showed various level of antiviral activity against Influenza virus. As a result of this study, this mouse experiment model, including intranasal treatment of live Lactobacillus species, could be effective model in evaluating immunomodulatory response of probiotics against respiratory viruses.

MyD88-BLT2-dependent cascade contributes to LPS-induced interleukin-6 production in mouse macrophage

Endotoxic responses to bacterial lipopolysaccharide (LPS) are triggered by Toll-like receptor 4 (TLR4) and involve the production of inflammatory mediators, including interleukin-6 (IL-6), by macrophages. The detailed mechanism of IL-6 production by macrophages in response to LPS has remained unclear, however. We now show that LPS induces IL-6 synthesis in mouse peritoneal macrophages via the leukotriene B4 receptor BLT2. Our results suggest that TLR4-MyD88 signaling functions upstream of BLT2 and that the generation of reactive oxygen species (ROS) by NADPH oxidase 1 (Nox1) and consequent activation of the transcription factor nuclear factor (NF)-kappaB function downstream of BLT2 in this response. These results suggest that a TLR4-MyD88-BLT2-Nox1-ROS-NF-kappaB pathway contributes to the synthesis of IL-6 in LPS-stimulated mouse macrophages.

A Two Case of 360 Degree Keratolimbal Allograft

PURPOSE: To report the clinical outcomes of 360-degree keratolimbal allograft in 2 patients. CASE SUMMARY: An 83-year-old female who had uncontrolled Mooren's ulcer invading 360 degrees of the limbus with corneal opacity received a 360-degree keratolimbal allograft (KLAL). Another 63-year-old female who had central corneal opacity and corneal neovascularization due to severe limbal cell deficiency with chemical injury received a 360-degree KLAL. During the average 17.5 months of follow-up, both eyes were tectonically maintained without severe graft rejection. CONCLUSIONS: A 360-degree KLAL may be an effective tectonic procedure for corneal opacity caused by limbal stem cell deficiency. Herein, we report 2 cases of successfully performed 360-degree KLAL with a literature review.

Up-regulation of BLT2 is critical for the survival of bladder cancer cells

The incidence rates of urinary bladder cancer continue to rise yearly, and thus new therapeutic approaches and early diagnostic markers for bladder cancer are urgently needed. Thus, identifying the key mediators and molecular mechanisms responsible for the survival of bladder cancer has valuable implications for the development of therapy. In this study, the role of BLT2, a receptor for leukotriene B4 (LTB4) and 12(S)-hydroxyeicosatetraenoic acid (HETE), in the survival of bladder cancer 253J-BV cells was investigated. We found that the expression of BLT2 is highly elevated in bladder cancer cells. Also, we observed that blockade of BLT2 with an antagonist or BLT2 siRNA resulted in cell cycle arrest and apoptotic cell death, suggesting a role of BLT2 in the survival of human bladder cancer 253J-BV cells. Further experiments aimed at elucidating the mechanism by which BLT2 mediates survival revealed that enhanced level of reactive oxygen species (ROS) are generated via a BLT2-dependent up-regulation of NADPH oxidase members NOX1 and NOX4. Additionally, we observed that inhibition of ROS generation by either NOX1/4 siRNAs or treatment with an ROS-scavenging agent results in apoptotic cell death in 253J-BV bladder cancer cells. These results demonstrated that a 'BLT2-NOX1/4-ROS' cascade plays a role in the survival of this aggressive bladder cancer cells, thus pointing to BLT2 as a potential target for anti-bladder cancer therapy.

Comparative study on the aflatoxin B1 degradation ability of rumen fluid from Holstein steers and Korean native goats

The aflatoxin B1 degrading abilities of two different ruminants were compared in this study. One set of experiments evaluated the aflatoxin B1 degradation ability of different rumen fluid donors (steers vs. goats) as well as the rumen fluid filtration method (cheese cloth filtered vs. 0.45 microm Millipore) in a 2 x 2 factorial arrangement. Additional studies examined aflatoxin B1 degradation by collecting rumen fluid at different times (0, 3, 6, 9 and 12 h) after feeding. Cannulated Holstein steers (740 +/- 10 kg bw) and Korean native goats (26 +/- 3 kg bw) were fed a 60% timothy and 40% commercial diet with free access to water. Rumen fluid from Korean native goats demonstrated higher (p < 0.01) aflatoxin B1 degradability than Holstein steers. However, filtration method had no significant influence on degradability. In addition, aflatoxin degradation did not depend upon rumen fluid collection time after feeding, as no significant differences were observed. Finally, a comparison of two types of diet high in roughage found aflatoxin degradability in goats was higher with timothy hay opposed to rice straw, although individual variation existed. Thus, our findings showed the aflatoxin degradability is comparatively higher in goats compared to steers.

Effects of Biofilm Formation on The Antimicrobial Susceptibility of Staphylococcus aureus

Staphylococcus aureus induces chronic infection in form of biofilm that exists in the host cells and arthroplastic prosthesis surface. In this study, the biofilm formation ability of S. aureus clinically isolated from bacteremia patients, biofilm processing and relationship of resistance to antibiotics, and difference of biofilm formation ability on different prosthetic material surfaces were studied. All of them formed biofilm and especially 6 strains of S. aureus had high ability of biofilm formation. In addition, it was found that some strains with higher biofilm formation ability make more higher polysaccharide layer production. When S. aureus ATCC 25923 forms biofilm, minimal bactericidal concentration (MBC) of biofilm bacteria is more increased than that of the planktonic state bacteria about one thousand folds. Especially, after 6 hours from starting on biofilm formation, the resistance to antibiotics was increased by more than 256 microgram/ml of MBC to every antibiotics and after 8 hours prominent increase (more than 4096 microgram/ml) was noted. Biofilm formation after bacterial adherence to plastic cover-slip was increased with time-dependent manner. Microcolonies were formed after 5 hours from a point that bacteria adhere to plastic cover-slip surface and after 6 hours biofilm was diffusely formed on entire surface, and then after 8 hours very thick biofilm was formed. Thicker biofilm was found on cobalt-chromium than titanium surface. These results suggest that titanium alloy materials are better than cobalt-chromium to minimize S. aureus biofilm formation on the arthroplastic material surface. Also, when microcolonies are formed after adherence of S. aureus to the arthroplastic material surface, resistance to antibiotics is starting.

TNF-alpha-induced up-regulation of intercellular adhesion molecule-1 is regulated by a Rac-ROS-dependent cascade in human airway epithelial cells

Up-regulation of intercellular adhesion molecule-1 (ICAM-1) in the lung airway epithelium is associated with the epithelium-leukocyte interaction, critical for the pathogenesis of various lung airway inflammatory diseases such as asthma. However, little is known about how ICAM-1 is up-regulated in human airway epithelial cells. In this study, we show that tumor TNF-alpha induces monocyte adhesion to A549 human lung airway epithelium and also up-regulation of ICAM-1 expression. These effects were significantly diminished by pre-treatment with diphenyliodonium (DPI), an inhibitor of NADPH oxidase-like flavoenzyme. In addition, the level of reactive oxygen species (ROS) was increased in response to TNF-alpha in A549 cells, suggesting a potential role of ROS in the TNF-alpha-induced signaling to ICAM-1 expression and monocyte adhesion to airway epithelium. Further, we found out that expression of Rac(N17), a dominant negative mutant of Rac1, suppressed TNF-alpha-induced ROS generation, ICAM-1 expression, and monocyte adhesion to airway epithelium. These findings suggest that Rac1 lies upstream of ROS generation in the TNF-alpha-induced signaling to ICAM-1 expression in airway epithelium. Finally, pretreatment with pyrrolidine dithiocarbamate (PDTC), an inhibitor of NF-kappaB, reduced TNF-alpha-induced ICAM-1 expression and both DPI and Rac(N17) significantly diminished NF-kappaB activation in response to TNF-alpha. Together, we propose that Rac1-ROS-linked cascade mediate TNF-alpha-induced ICAM-1 up-regulation in the airway epithelium via NF-kappaB-dependent manner.

Effects of an Information Protocol on Anxiety and Nursing Satisfaction for Family Caregivers of Cerebrovascular Accident Patients in the ICU / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the effects of an information protocol for anxiety and nursing satisfaction of family caregivers. The caregivers were caring for a family member who had a CVA (cerebrovascular accident) and who had been admitted to the ICU (intensive care unit). METHOD: The research design was a non-equivalent control group non-synchronized design. Data were collected from April 1 to October 31, 2005 at D hospital in Busan City. The participants were 40 family caregivers of patients with a CVA admitted to the ICU. Caregivers in the experimental group participated in the information protocol for 30 min. Both groups were pre-tested before the intervention for two variables, anxiety and nursing needs. The post-test of both groups included anxiety and nursing satisfaction. The instruments used in this study were the Spielberger's state anxiety inventory (1976) and the nursing satisfaction scale developed by Molter (1979). RESULTS: Anxiety scores were significantly lower and nursing satisfaction scores were significantly higher for caregivers in the experimental group compared to those in the control group. CONCLUSION: The information protocol was effective in reducing anxiety and increasing the level of nursing satisfaction of family caregivers caring for an ICU patients with a CVA.

Establishment of Reference Value Using Korean Adult Medical Checkup Data and Interpretation of Test Results / 임상검사와정도관리

BACKGROUND: There is room for doubt that the reference intervals currently used in many hospitals or health institutions in Korea are appropriate, because some scientists do not agree that the selections of reference individuals were valid universally. If we adopt the inappropriate reference intervals in the decision making of examinees' health status, we are liable to lead to false-negatives or false-positives. METHODS: We selected 555 healthy and 2,134 unhealthy adult samples who took medical check-up at an institution between 2000 and 2004 through semi-stratified random sampling method. Disease groups were divided into 7 subgroups: hepatic, gastrointestinal, obesity, circulatory, endocrine, urogenital and others. RESULTS: Through parametric and non-parametric methods, we produced new reference intervals and compared the newly developed intervals with current ones. Some reference values should be adjusted newly; ALT-male < or =33 IU/L, ALT-female < or =22 IU/L, AST < or =28 IU/L, cholesterol < or =198 mg/dL, triglyceride-male < or =172 mg/dL, triglyceride-female < or =133 mg/dL, fasting blood sugar 65-101 mg/dL. CONCLUSIONS: In order to reduce the rate of false-positives or false-negatives, we suggest that reference ranges of some items might be reestablished or adjusted according to gender through the further studies on current reference ranges.

Comparison Between Standard and elevated-rim Acetabular Liner in Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: Elevated-rim acetabular liner enhances stability in total hip arthroplasty and has been widely accepted. But it has potential adverse effects. So, we assessed the effects of the elevated-rim acetabular liner clinically and radiologically. MATERIALS AND METHODS: We reviewed the results of 74 total hip arthroplasties of 64 patients that had been performed from January 1993 to March 1995. Thirty-six cases of the 74 cases used elevated rim acetabular liner and 38 cases did standard liner. Dislocation rate, Harris hips score, osteolysis and revision rate were compared between two groups. RESULTS: There were no significant differences in mean anteversion, abduction angles of the cup and femoral offsets between two groups. Four of the 38 cases with the standard liner had a dislocation, compared with one of 36 cases with the elevated-rim liner (P=0.358) . Femoral osteolysis was observed 7 cases (18.4%) in the standard liner group and 14 cases (38.8%) in the elevated-rim liner group. Acetabular osteolysis was observed 17 cases (44.7%) in the standard group and 21 cases (58.3%) in the elevated-rim group. Nine cases (23.6%) had been revised in the standard group and 6 cases (16.6%) in the elevated group. CONCLUSION: Excessive wear and breakage of the polyethylene by impingement was developed in the elevated-rim polyethylene liner.

Cementless Hip Arthroplasty in Patients with Avascular Necrosis of the Femoral Head: Long term results in AML / 대한정형외과학회잡지

PURPOSE: We reviewed the clinical and radiological outcomes of total hip arthroplasty and bipolar hemiarthroplasty for avascular necrosis of the femoral head. MATERIALS AND METHODS: From January 1986 to December 1989, 24 cases were treated with total hip arthroplasty and 27 cases with bipolar hemiarthroplasty for avascular necrosis of the femoral head. Clinical outcomes were assessed using Harris Hip Score. Serial radiographs of the hip were used to assess stability of the femoral component, change of the acetabular cup angle, osteolysis of acetabulum or femur, wear of polyliner and erosion of the acetabular cartilage. RESULTS: The average Harris Hip Score was 93.1 in bipolar hemiarthroplasty group and 86.8 in total hip arthroplasty group at last follow up. Femoral osteolysis was observed in 17 patients of 24 total hip arthroplasties and in 14 patients of 27 bipolar hemiarthroplasties. Acetabular osteolysis was observed in 8 cases of 24 total hip arthroplasties. Revision was undertaken 8 cases (33.3%) in the total hip arthroplasty group and 6 cases (22.2%) in the bipolar hemiarthroplasty group. The main causes of revision were wear of polyliner and severe osteolysis in the total hip arthroplasty group and erosion of the acetabular cartilage in the bipolar arthroplasty group. CONCLUSION: The main cause of failure after total hip arthroplasty for avascular necrosis of the femoral head was using a 32 mm femoral head and a polyliner less than 8mm thickness.