Delayed Treatment of Capsaicin Produces Partial Motor Recovery by Enhancing Dopamine Function in MPP⁺-lesioned Rats via Ciliary Neurotrophic Factor

Transient receptor potential vanilloid subtype 1 (TRPV1) on astrocytes prevents ongoing degeneration of nigrostriatal dopamine (DA) neurons in MPP⁺-lesioned rats via ciliary neurotrophic factor (CNTF). The present study determined whether such a beneficial effect of astrocytic TRPV1 could be achieved after completion of injury of DA neurons, rather than ongoing injury, which seems more relevant to therapeutics. To test this, the MPP⁺-lesioned rat model utilized here exhibited approximately 70~80% degeneration of nigrostriatal DA neurons that was completed at 2 weeks post medial forebrain bundle injection of MPP⁺. TRPV1 agonist, capsaicin (CAP), was intraperitoneally administered. CNTF receptor alpha neutralizing antibody (CNTFRαNAb) was nigral injected to evaluate the role of CNTF endogenously produced by astrocyte through TRPV1 activation on DA neurons. Delayed treatment of CAP produced a significant reduction in amphetamine-induced rotational asymmetry. Accompanying this behavioral recovery, CAP treatment increased CNTF levels and tyrosine hydroxylase (TH) activity in the substantia nigra pars compacta (SNpc), and levels of DA and its metabolites in the striatum compared to controls. Interestingly, behavioral recovery and increases in biochemical indices were not reflected in trophic changes of the DA system. Instead, behavioral recovery was temporal and dependent on the continuous presence of CAP treatment. The results suggest that delayed treatment of CAP increases nigral TH enzyme activity and striatal levels of DA and its metabolites by CNTF endogenously derived from CAP-activated astrocytes through TRPV1, leading to functional recovery. Consequently, these findings may be useful in the treatment of DA imbalances associated with Parkinson's disease.

A Novel Germline Mutation of the APC Gene: A Case Report of Familial Adenomatous Polyposis Requiring Repeated Endoscopic Resections for Gastroduodenal Polyps

Familial adenomatous polyposis (FAP) is a precancerous clinical entity, which is characterized by the development of numerous adenomatous polyps throughout the colon and rectum. The majority of FAP are associated with mutations of the adenomatous polyposis coli (APC) gene. Until now, more than 1,000 different APC mutations have been reported and some mutations express attenuated phenotypes which are milder forms with 10~100 colorectal polyps. We identified a novel mutation of APC gene which expressed an attenuated FAP but caused large gastroduodenal tubular adenomas requiring repeated endoscopic resections. A 16-year-old girl was referred to Incheon St. Mary's Hospital for evaluation of gastric polyposis. Initial esophagogastroduodenoscopy (EGD) showed numerous gastric polyps in the fundus and upper body and a few polyps in the duodenum. Pathologic examination confirmed gastric polyps as fundic gland polyps and duodenal polyps as tubular adenomas. Only a few colonic polyps of 2 to 5 mm in size were found on colonoscopy. Genetic analysis using polymerase chain reaction and direct sequencing revealed a novel stop codon mutation at codon 1522 in exon 16 of APC gene. At 12-month, 18-month, and 35-month follow-up EGD, large duodenal polyp and gastric polyps were removed endoscopically.

Efficiency of an Automated Reception and Turnaround Time Management System for the Phlebotomy Room

BACKGROUND: Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. METHODS: The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. RESULTS: Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. CONCLUSIONS: The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.

De novo Leukemic Variant of Mast Cell Leukemia With KIT D816V

No abstract available.

Activities of Quality Improvement for Blood Culture at a University Hospital / 대한임상미생물학회지

BACKGROUND: Blood culture is a critical test for diagnosing bloodstream infections. Frequent microbial contamination during sampling and testing leads to abuse of antimicrobial agents. We evaluated methods for reducing contamination and obtaining more reliable results. METHODS: We analyzed blood cultures obtained between 2009 and 2015. We established 6 quality indicators: true positive rate, contamination rate, blood sampling volume, number of sets of blood cultures, delayed transportation rate, and percentage of samples collected from the femoral region, with reference to the CLSI guideline M47-A, 2007. Education was provided for interns and nurses responsible for blood sampling and transportation of specimens, and data were analyzed monthly. RESULTS: At baseline, the true positive rate was 12.8%, and the contamination rate was 4.0%. During the intervention period, these were decreased to 10.9% and 1.9%, respectively. The percentage of samples smaller than 5 mL decreased from 29.7% to 2.7-11.3%. The rate of one set of blood cultures being ordered was always <5%. The delayed transportation rate decreased from 35.6% to 5.5-7.7%. Finally, the percentage of samples collected from the femoral region decreased from 41.5% to 22.0-31.0%, because of which we did not attain our goal, 20.8%. CONCLUSION: The results showed improvements in contamination rate, specimen volume, specimen transportation time, and the percentage of samples collected from the femoral region. The quality management of blood cultures in 2011 was comparatively poor, which led to increased contamination rate, large number of samples containing <5 mL of blood, and increased percentage of samples collected from the femoral region. Thus, quality improvement methods can produce more reliable results of blood cultures.

Comparison of Total and IgG ABO Antibody Titers in Healthy Individuals by Using Tube and Column Agglutination Techniques

BACKGROUND: Most immune reactions related to transfusion and transplantation are caused by IgM ABO antibodies. However, IgG also plays an important role in these reactions. Therefore, a method to measure antibodies, including IgG, is necessary. We investigated ABO antibody titers of healthy individuals using a column agglutination technique (CAT) with or without dithiothreitol (DTT) and compared them with titers obtained using a conventional tube method. METHODS: Among healthy adults who underwent a medical examination, 180 individuals (60 with blood group A, 60 with group B, and 60 with group O) were selected. Antibody titrations were performed using the immediate spin (IS) tube, anti-human globulin (AHG) tube, and CAT with or without DTT methods. RESULTS: Higher median values of anti-B and anti-A titers in groups A and B individuals, respectively, were obtained using the IS method than using the AHG method. Higher values for group O individuals were obtained using the AHG method. Higher median titers of anti-B and anti-A in group O individuals were obtained using CAT without DTT than using the AHG method. Median titers of anti-B and anti-A in all blood groups were higher in CAT without DTT than in CAT with DTT, especially for group O individuals. CONCLUSIONS: We recommend CAT with and without DTT for titration of anti-A and anti-B, especially in group O individuals, to provide more sensitive results that include IgG data. Adjustment of insurance coverage of fees associated with antibody titration might be necessary, considering the actual cost of reagents and personnel.

Evaluation of the OraQuick HCV Rapid Antibody Test as a Screening Test for Hepatitis C Virus Infection / 임상검사와정도관리

BACKGROUND: Among the multitude of tests developed for the diagnosis of hepatitis C virus (HCV) infection, the enzyme immunoassay and the chemiluminescence immunoassays (CLIA) are the most commonly used. The OraQuick HCV Rapid Antibody Test is also popular because it can detect HCV antibodies from blood or saliva within 20 minutes. In this study, we compared the performances of the OraQuick HCV Rapid Antibody Test and CLIA in the diagnosis of HCV infection. METHODS: We tested 150 serum samples from Soonchunhyang University Seoul Hospital for HCV between November 2012 and January 2013 using CLIA (ADVIA Centaur) as well as the OraQuick test. The data from both tests were compared to the results of HCV real-time PCR (COBAS AmpliPrep/COBAS TaqMan HCV test kit). RESULTS: In the PCR analysis, 59 of the 150 samples (39.3%) tested positive and 91 (60.7%) tested negative for HCV RNA. All these samples also tested positive when screened by CLIA. However, only 57 of 59 samples tested positive with the OraQuick test. Among the 91 samples found to be HCV-negative in the PCR analysis, 50 tested negative in both CLIA and the OraQuick tests. However, a discrepancy was noted among the remaining 41 samples that tested HCV-negative in the PCR analysis; 21 of these samples tested positive in both CLIA and the OraQuick tests, but the remaining 20 tested positive only in CLIA. CONCLUSIONS: Although the OraQuick test showed a marginally lower sensitivity for HCV detection than CLIA, we conclude that it is still beneficial because it is rapid and can be performed using blood and saliva samples. Our findings suggest that the OraQuick test could be an important diagnostic tool for screening HCV infection.

Gastric Adenocarcinoma of Fundic Gland Type: Report of Three Cases

Recently, fundic gland type gastric adenocarcinoma (GA-FG) has been reported as a new entity. This report describes GA-FG among Koreans for the first time. From March 2008 to July 2010 we identified only three cases of GA-FG out of over 6,000 GAs resected by endoscopy or surgery. Cell differentiation by mucin proteins, pepsinogen-I, and H+/K+-ATPase was evaluated. All three cases were male patients and diagnosed as early stage GA. Histologically, GA-FGs were well-differentiated adenocarcinoma with pale gray-blue, basophilic columnar or cuboidal cells and mildly enlarged nuclei, resembling chief cells. All three cases were positive for pepsinogen-I and were classified as gastric mucin phenotype. Among three histologic subtypes of GA-FG, since tumors were mainly composed of chief cells, our three cases were classified as chief cell predominant type. In conclusion, GA-FG is very rare among Koreans and pepsinogen-I and MUC6 expression are typical immunohistochemical findings in GA-FG suggesting differentiation toward fundic glands.

Gastric Adenocarcinoma of Fundic Gland Type: Report of Three Cases

Recently, fundic gland type gastric adenocarcinoma (GA-FG) has been reported as a new entity. This report describes GA-FG among Koreans for the first time. From March 2008 to July 2010 we identified only three cases of GA-FG out of over 6,000 GAs resected by endoscopy or surgery. Cell differentiation by mucin proteins, pepsinogen-I, and H+/K+-ATPase was evaluated. All three cases were male patients and diagnosed as early stage GA. Histologically, GA-FGs were well-differentiated adenocarcinoma with pale gray-blue, basophilic columnar or cuboidal cells and mildly enlarged nuclei, resembling chief cells. All three cases were positive for pepsinogen-I and were classified as gastric mucin phenotype. Among three histologic subtypes of GA-FG, since tumors were mainly composed of chief cells, our three cases were classified as chief cell predominant type. In conclusion, GA-FG is very rare among Koreans and pepsinogen-I and MUC6 expression are typical immunohistochemical findings in GA-FG suggesting differentiation toward fundic glands.

Acute hypertensive pulmonary edema after Cesarean section in a patient with an antepartum myocardial infarction: A case report / 대한마취과학회지

We report a case of 29-year-old, morbidly obese, diabetic primigravida who had undergone previously primary percutaneous coronary intervention with stent placement for an inferior wall myocardial infarction at 10 weeks of gestation. She remained asymptomatic with medication during the remainder of her pregnancy, but preoperative echocardiography revealed left ventricular dilation and a restrictive diastolic dysfunction with a preserved ejection fraction (46%). She developed acute pulmonary edema associated with hypertension after an elective Cesarean delivery under continuous epidural anesthesia despite the meticulous restriction of fluid.

Airway Obstruction Caused by Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion: A Case Report / 대한구급학회지

Acute airway obstruction after anterior cervical surgery is rare, but does occur. Airway obstruction due to prevertebral soft tissue swelling is unpredictable, but potentially lethal. We managed a 67-year-old male who developed acute airway obstruction caused by marked prevertebral soft tissue swelling on the first day after anterior cervical discectomy and fusion at the C4-C5 level.

A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation / 대한마취과학회지

BACKGROUND: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. METHODS: One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery. RESULTS: There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction. CONCLUSIONS: Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

Comparison of Liqui-PREP(TM) and Conventional Preparations in Thyroid Fine Needle Aspiration

BACKGROUND: Liqui-PREP(TM) (LP) is a new liquid-based cytologic preparation that produces a thin layer of cells. METHODS: Thyroid aspirates were obtained from 189 patients and divided to prepare pairs of conventional preparation (CP) and LP slides. The CP slides were routinely diagnosed by attending staffs and classified into the six categories. LP slides were independently evaluated by three cytopathologists and classified in an identical manner. Agreements between CP and LP diagnoses were investigated and interobserver variability of thyroid aspiration cytology results obtained using the LP method was determined using kappa values. RESULTS: CP and LP slides from 155 patients (83%) were identically classified by all of three cytopathologists. Concurrences between CP and LP diagnoses for the three cytopathologists were 89% (kappa=0.78), 92% (kappa=0.87), and 85% (kappa=0.70), respectively. Interobserver agreement among the three cytopathologists for LP slides ranged from substantial to almost perfect (kappa=0.84, 0.74 and 0.84). However, a lack of interobserver agreement was found for LP slides of the undetermined category as determined by original CP-based diagnoses. Moreover, cytomorphological alterations in the benign category appeared more worrisome for LP slides. CONCLUSIONS: An awareness of the novel cytomorphologic changes induced by the LP method is needed to avoid misinterpretations.

Placental Transmogrification of the Lung: A Brief Case Report

Placental transmogrification (PT) is an unusual condition in which the alveoli develop a peculiar villous configuration that resembles the placental villi. We report a rare case of pulmonary PT in a 46-year-old man who presented with multiple cystic lesions and nodules on radiography. The patient was treated with a surgical excision. The cut surface of the lung lesion had a villous spongiform manifestation with a partly yellow granular appearance. Microscopically, multiple papillary cores mimicking the villous structures of the placenta were observed within the bullous airspaces. These papillary cores contained many vascular structures, lymphoid aggregates, interstitial clear cells, mature fat and dystrophic calcification. This case was solitary and not associated with other pulmonary or systemic diseases. The etiology is unknown, and further studies will be needed to understand the pathogenesis of the lesion.

Management of the Third Molar Tooth in Mandibular Angle Fracture

The management of the third molar tooth in mandibular angle fracture is still controversial. Retrospective analysis of 197 cases of mandibular angle fractures associated with third molar tooth was undertaken. Selective prophylactic extraction of the third molar teeth were undertaken in 66 cases. The third molar teeth were retained in 131 fractures. The indication of extraction of the third molar teeth in mandibular angle fracture were as follows: 1) interfering with reduction of the fracture; 2) excessive mobility; 3) exposure of tooth root due to distraction of the fracture; 4) fractured teeth; 5) severely carious tooth 6) infected supporting structure. There were no significant differences between the complication rate in the "tooth removed" group and "tooth retained" group. Complications were minimal. Therefore proper management of the third molar tooth in mandibular angle fracture will minimize complication.

A Clinical Experience and Treatment of Panfacial Fracture

Panfacial fracture defines that fractures include all upper face, midface, and lower face. But clinically it means fracture more than two areas including midface. Many panfacial fracture patients have injury of cranium and face. Serious soft tissue damage and bony defect are frequent, normal anatomical reconstruction is difficult. After primary treatment many patients have sequelae of functional and aesthetic deformities, which are difficult to restore by secondary reconstruction. Patients with panfacial fracture are 75 cases among 1138 facial bone fractures who received treatment in department of plastic and reconstructive surgery of our university. We followed up survey from January, 1997 to December, 2001 by retrospective study and came to a conclusion. First, interconnection between skull base and nasal cavity must be seperated perfectly. Second, telecanthus can be prevented by anatomical bone fixation. Third, surgeon reconstruct zygomatic area exactly for facial width and projection. Forth, surgeon restore normal occlusion by anatomic reduction of maxilla and mandible. Fifth, soft tissue must be repaired layer by layer for prevention of secondary contour deformity. In conclusion, surgeon decides operation methods and time after discuss with related departments for with patient's condition. And treatment plans are based on patients mental and physical state. Proper primary treatment can reduce complications and necessity of secondary operation.