Comparison of putative circulating cancer stem cell detection between the hepatic portal system and peripheral blood in colorectal cancer patients

PURPOSE: The present pilot study was conducted to detect putative cancer stem cell (CSC) from the hepatic portal system and peripheral blood in the colorectal cancer patients and to compare them to healthy donor and diverticulitis patients. METHODS: Laboratory study was performed to identify the expression of cell surface markers, epithelial cell adhesion molecule (EpCAM), cytokeratin (CK) 18, CK20, CD44, and CD133, on several colon cancer cell lines. Clinical pilot study was conducted to detect putative circulating CSC as EpCAM+CD133+ cell in colorectal cancer (n = 10), diverticulitis (n = 5), and four healthy donors, by using flow cytometry. Blood was drawn from the hepatic portal system and peripheral vein. RESULTS: On laboratory study, EpCAM was expressed in whole colon cancer cell lines, and CD44 and CD133 were simultaneously expressed in 50% of the cell lines with stemness phenotype, but CK18 and CK20 were not expressed in most of the cell lines. On clinical study, the mean EpCAM+CD133+ cell counts of 11.6/105 in the hepatic portal system were somewhat lower than 15.4/105 in peripheral vein (P = 0.241). As for diverticulitis patients, EpCAM+CD133+ cells were also detected to have steeper dropped to near zero, after the surgery. CONCLUSION: The numbers of putative CSC were not statistically different between the detection sites of the portal vein and peripheral vein in the colon cancer patients. Therefore, we may not have benefitted by getting the cells from the hepatic portal system. In addition, the CD133+EpCAM+ cells in the colon cancer patients might contain normal stem cells from cancer inflammation similar to diverticulitis.

Perforator-Based Propeller Flap for Lower Extremity Reconstruction

PURPOSE: To report the clinical results of the perforated-based propeller flap for lower extremity soft tissue reconstruction. MATERIALS AND METHODS: Between January 2010 and June 2012, a total of 16 defects in the lower extremities were covered with perforator-based propeller flaps. Retrospective data for location and size of the defect, flap dimension, pedicle artery, pedicle rotation, complications were obtained. RESULTS: Peroneal artery-based perforator flap were used in eleven cases, posterior tibial artery-based perforator flap in two cases, anterior tibial artery-based perforator flap in one case and medial plantar artery-based perforator flap in two cases. The average size of the flaps was 63 cm2. The marginal skin necrosis of the flaps as a complication was developed in two cases, one of which was covered with split-thickness skin graft. There were no functional deficits from the donor site. CONCLUSION: For the reconstruction of lower extremities, the perforator-based propeller flap could be a reasonable alternative as it is a simple, safe and versatile technique.

Changing Trends in the Occurrence and Management of Delirium for 5 Years in a University Hospital / 정신신체의학

OBJECTIVES: Delirium is a disorder defined as a sudden disturbance in thinking, speaking, acting and sleep pattern due to altered level of consciousness and cognitive function. The objective of this study is to analyze characteristics and therapeutic methods of the delirious patients during the recent 5 years, and provide basic data for further studies and investigation regarding delirium in the occurrence and treatment. METHODS: We retrospectively reviewed medical records of 475 patients who were consulted for delirium in Kyunghee University Medical Center from January 2007 to December 2011. RESULTS: During the 5 years, among the 475 patients who were diagnosed as delirium, men were more common(61.7%). The most commonly consulted reason and cause were sleep disturbance(80.8%) and post-operational delirium(30.9%), respectively. The medication prescription percentage was 76.6% and was significantly increased year after year. Ratio of using antipsychotics were 76.4% among prescribed medication and the most frequently prescribed antipsychotic drug was quetiapine(46.8%). Other specialists commonly misdiagnosed delirium when the patient was previously diagnosed as dementia(6.8%). CONCLUSIONS: In our study, post-operational delirium was the most commonly referred reason and the percentage of medication prescription tended to increase. Patients with history of dementia were more easily misdiagnosed as diseases other than delirium. Our study suggests that we should evaluate symptoms, causes, reasons of consultation, management tendency of delirium. We should also closely observe changes in sleep patterns and establish the prevention strategies for post-operational delirium and therapeutic bases for pharmacotherapy.

Carpometacarpal Joint Dislocation of the Thumb Associated with Fracture of the Trapezium: A Case Report

We report a dislocation of the thumb carpometacarpal joint associated with an oblique fracture of the trapezium. This case was treated with open reduction and internal fixation using two Kirschner wires for the trapezial fracture and repair of the ruptured dorsal capsular ligament and additional Kirschner wire fixation for the carpometacarpal joint stability. At the 12 months follow-up examination, there was no pain or chronic instability. There was no evidence of post-traumatic arthritic changes.

Effects of sevoflurane on wound healing process / 대한마취과학회지

BACKGROUND: Wound healing process is a tissue response to trauma which leads to tissue repair through complex biological stages. Sevoflurane is a widely used inhalation anesthetic for surgery, but there has been no study about its effect on wound healing process. This study was undertaken to evaluate the effect of sevoflurane on wound healing process. METHODS: Male Sprague-Dawley rats (200-300 g) were used. Two circular full-thickness skin defects of 8 mm in diameter were made on dorsum of rats. After wound formation, the animals were divided into 4 groups: 1, 2, 4, 8 hr exposure to sevoflurane, respectively. Wound sizes and regional blood flow around the wounds were measured. The expression of basic fibroblast growth factor (bFGF), transforming growth factor beta1 (TGFbeta1), collagen 1, and collagen 3 mRNA were detected 7 days after wound formation by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: Wound size was significantly increased in 8 hr group at 3 and 7 days after wound formation. Regional blood flow was significantly decreased in 4 hr and 8 hr groups at 3 days after wound formation. The bFGF, collagen 1 and 3 mRNA expressions were significantly decreased in 8 hr exposure group. CONCLUSIONS: These results suggest that sevoflurane exposure influences the regional blood flow, wound size, expression of bFGF, and production of collagen 1 and 3 during the wound healing process.

Increase of NKG2D ligands and sensitivity to NK cell-mediated cytotoxicity of tumor cells by heat shock and ionizing radiation

In this study, we have investigated if current cancer therapeutic modalities including hyperthermia and ionizing radiation can increase the expression of NKG2D ligands in human cancer cell lines. The expressions of NKG2D ligands were induced by both heat shock and ionizing radiation in various cell lines including KM12, NCI-H23, HeLa and A375 cells with peaks at 2 h and 9 h after treatment, respectively, although inducibility of each NKG2D ligand was various depending on cell lines. During the induction of NKG2D ligands, heat shock protein 70 was induced by heat shock but not by ionizing radiation. These results were followed by increased susceptibilities to NK cell-mediated cytolysis after treatment with heat shock and ionizing radiation. These results suggest that heat shock and ionizing radiation induce NKG2D ligands and consequently might lead to increased NK cell-mediated cytotoxicity in various cancer cells.

Radiosensitization by targeting radioresistance-related genes with protein kinase A inhibitor in radioresistant cancer cells

Here we determined which radiation-responsive genes were altered in radioresistant CEM/IR and FM3A/IR variants, which showed higher resistance to irradiation than parental human leukemia CEM and mouse mammary carcinoma FM3A cells, respectively and studied if radioresistance observed after radiotherapy could be restored by inhibition of protein kinase A. The expressions of DNA-PKcs, Ku70/80, Rad51 and Rad54 genes that related to DNA damage repair, and Bcl-2 and NF-kappaB genes that related to antiapoptosis, were up-regulated, but the expression of proapototic Bax gene was down-regulated in the radioresistant cells as compared to each parental counterpart. We also revealed that the combined treatment of radiation and the inhibitor of protein kinase A (PKA) to these radioresistant cells resulted in synergistic inhibition of DNA-PK, Rad51 and Bcl-2 expressions of the cells, and consequently restored radiosensitivity of the cells. Our results propose that combined treatment with radiotherapy and PKA inhibitor can be a novel therapeutic strategy to radioresistant cancers.

Association of DNA-dependent protein kinase with hypoxia induciblefactor-1 and its implication inresistance to anticancer drugs in hypoxic tum or cells

Tumor hypoxia contributes to the progression of a malignant phenotype and resistance to ionizing radiation and anticancer drug therapy. Many of these effects in hypoxic tumor cells are mediated by expression of specific set of genes whose relation to therapy resistance is poorly understood. In this study, we revealed that DNA-dependent protein kinase (DNA-PK), which plays a crucial role in DNA double strand break repair, would be involved in regulation of hypoxia inducible factor-1 (HIF-1). HIF-1beta-deficient cells showed constitutively reduced expression and DNA-binding activity of Ku, the regulatory subunit of DNA-PK. Under hypoxic condition, the expression and activity of DNA- PK were markedly induced with a concurrent increase in HIF-1alpha expression. Our result also demonstrated that DNA-PK could directly interact with HIF- and especially DNA-PKcs, the catalytic subunit of DNA-PK, could be involved in phosphorylation of HIF-1alpha, suggesting the possibility that the enhanced expression of DNA- PK under hypoxic condition might attribute to modulate HIF-1alpha stabilization. Thus, the correlated regulation of DNA-PK with HIF-1 could contribute to therapy resistance in hypoxic tumor cells, and it provides new evidence for developing therapeutic strategies enhancing the efficacy of cancer therapy in hypoxic tumor cells.

Clinical Analysis of Pediatric Neurosurgical Diseases

The authors analyzed pediatric(under 15-year of age) neurosurgical disease patients admitted to the Department of Neurosurgery, Yeungnam University Hospital during the 6-year period from May 1983 to April 1989. The results were as follows : 1) Among the total 5,007 neurosurgical admission cases during this period, pediatric cases were 573(11.4%). 2) The total pediatric cases consist of traumatic(80.1%), tumor(5.9%), congenital anomaly(3.1%), infection(3.1%), vascular anomaly(2.1%) and miscellaneous(5.6%) lesions. 3) The male to female ratio was 1.67 : 1 in trauma. 4) The most common age of trauma are 3 to 8 years. 5) The incidence of trauma was relatively common in spring and autumn. 6) The traffic accident is most common cause of pediatric trauma. 7) The contusion case with GCS 9 to 15 revealed good result. 8) 23.1% of 108 intracranial hematoma had no skull fracture. 9) Mortality in trauma was relatively low(1.8%) compared to adult.