GPR40 Agonism Modulates Inflammatory Reactions in Vascular Endothelial Cells

Endothelial dysfunction is strongly linked with inflammatory responses, which can impact cardiovascular disease. Recently, G protein-coupled receptor 40 (GPR40) has been investigated as a modulator of metabolic stress; however, the function of GPR40 in vascular endothelial cells has not been reported. We analyzed whether treatment of GPR40-specific agonists modulated the inflammatory responses in human umbilical vein endothelial cells (HUVECs). Treatment with LY2922470, a GPR40 agonist, significantly reduced lipopolysaccharide (LPS)-mediated nuclear factor-kappa B (NF-κB) phosphorylation and movement into the nucleus from the cytosol. However, treatment with another GPR40 agonist, TAK875, did not inhibit LPS-induced NF-κB activation. LPS treatment induced expression of adhesion molecules vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) and attachment of THP-1 cells to HUVECs, which were all decreased by LY2922470 but not TAK875. Our results showed that ligand-dependent agonism of GPR40 is a promising therapeutic target for overcoming inflammatory reactions in the endothelium.

Sestrin2 Regulates Beneficial β3-Adrenergic Receptor-Mediated Effects Observed in Inguinal White Adipose Tissue and Soleus Muscle

Sestrin2, a well-known adenosine monophosphate-activated protein kinase (AMPK) regulator, plays a protective role against metabolic stress. The β3-adrenergic receptor (β3AR) induces fat browning and inhibits muscle atrophy in an AMPK-dependent manner. However, no prior research has examined the relationship of sestrin2 with β3AR in body composition changes. In this study, CL 316,243 (CL), a β3AR agonist, was administered to wild-type and sestrin2-knockout (KO) mice for 2 weeks, and fat and muscle tissues were harvested. CL induced AMPK phosphorylation, expression of brown-fat markers, and mitochondrial biogenesis, which resulted in the reduction of lipid droplet size in inguinal white adipose tissue (iWAT). These effects were not observed in sestrin2-KO mice. In CL-treated soleus muscle, sestrin2-KO was related to decreased myogenic gene expression and increased levels of muscle atrophy-related molecules. Our results suggest that sestrin2 is associated with beneficial β3AR-mediated changes in body composition, especially in iWAT and in the soleus.

Effect of the lateral tilt position on femoral vein cross-sectional area in anesthetized adults

BACKGROUND: A lateral tilt position can affect the size of the femoral vein (FV) due to increased venous blood volume in the dependent side of the body. METHODS: Forty-two patients, aged 20–60 years, were enrolled in this study. The crosssectional area (CSA), anteroposterior, and transverse diameters of the FV were measured 1 cm below the left inguinal line using ultrasound. The value of each parameter was recorded in the following four positions: (1) supine, (2) supine + 10° left-lateral tilt (LLT), (3) 10° reverse Trendelenburg (RT), and (4) RT + LLT. RESULTS: CSAs of the left FV in the supine, supine + LLT, RT, RT + LLT positions were 0.93 ± 0.22, 1.11 ± 0.29, 1.17 ± 0.29, and 1.31 ± 0.32 cm2, respectively. Compared to the supine position, there was a significant increase in CSA and anteroposterior diameter according to the three changed positions. The transverse diameter of the left FV was significantly increased in supine + LLT, RT, RT + LLT positions compared to that in the supine position (P = 0.010, P = 0.043, P = 0.001, respectively). There was no significant difference in the transverse diameter of the left FV between the supine + LLT and RT positions (P = 1.000). CONCLUSIONS: Adding LLT to the supine and RT positions increased the CSA of the unilateral FV significantly.

Hemodynamic Effects of Co-administration of Midazolam during Anesthesia Induction with Propofol and Remifentanil in Hypertensive Patients / 고신대학교의과대학학술지

OBJECTIVES: Propofol, midazolam and remifentanil are commonly used for clinical anesthesia. We compared the effects of midazolam-propofol-remifentanil and propofol-remifentanil on hemodynamic responses during anesthesia induction in hypertensive patients. METHODS: Seventy-six hypertensive patients with ASA II-III were assigned to receive midazolam-propofol (group MP; n = 38) or propofol (group P; n = 38). Anesthesia was induced with midazolam 0.03 mg/kg (group MP) or saline 0.03 ml/kg (group P). After two minutes, propofol 1.0 mg/kg (group MP) or 1.5 mg/kg (group P) i.v. bolus was administered. Simultaneously, 4 ng/ml of remifentanil target controlled infusion (TCI) was administered in both groups. Anesthesia was maintained using sevoflurane and 2 ng/ml of remifentanil TCI. Systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP) and heart rate (HR) were measured before induction, 2 min after midazolam or normal saline, 2 min after propofol, 1 min after rocuronium, and immediately, 1 min, 2 min, and 3 min after intubation. RESULTS: SBP, DBP, and MBP decreased after propofol administration and increased immediately after intubation in both groups (P < 0.05). After intubation, SBP, DBP, and MBP decreased more than baseline values in either group. Although the overall BP of Group P was lower than that of Group MP, there were no significant differences except for SBP at 2min after intubation (P < 0.05). HR was no significant difference in either group. CONCLUSION: Our results suggest that midazolam-propofol-remifentanil has similar hemodynamic effect with propofol-remifentanil during anesthesia induction in hypertensive patients.

Late recurarization in the post-anesthetic care unit after total thyroidectomy: A case report

Residual paralysis, recurarization is defined as a remnant effect of neuromuscular blocking after surgery that can cause postoperative complications. Clinical complications of recurarization include dyspnea, gastric content aspiration, and atelectasis. Therefore, complete recovery of muscle strength at the end of surgery is a significant factor for patient safety. We report a case of a 53-year-old woman who presented with residual paralysis after total thyroidectomy. To improve her condition, we injected sugammadex intravenously in the post-anesthetic care unit. After that, we observed her for 1 hour and her muscle strength gradually recovered. She did not have any symptoms on the next day and was discharged on the 5th post-operative day.

Empiric Therapy with Cefazolin and Ceftazidime (or Aminoglycoside) is Effective as the Initial Choice for the Treatment of Peritoneal Dialysis Related Peritonitis / 대한신장학회잡지

BACKGROUND: This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis (ISPD) guideline for PD related peritonitis among the Korean PD population. METHODS: 227 episodes of PD-related peritonitis from January 2000 to June 2003 in two tertiary care hospitals were reviewed retrospectively for the antibiotic resistance pattern and their clinical outcome after treatment based on the ISPD guideline. RESULTS: There was 349 prevalent patients during this period. The incidence of peritonitis was 1 episode/41.3 patient-month. For 173 episodes, the etiologic organism was identified. Among the isolates, 99 (43.6%) were gram positive organisms and 57 (25.1%) were gram negative organisms. Among gram positive bacterial peritonitis, multiple logistic regression analysis showed that antibiotic resistance was not a risk factor for treatment failure (OR=0.84, p=0.79). Among the 45 cases with Staphylococcus- associated peritonitis, and empirical cefazolin and ceftazidime (or aminoglycoside) administration, 27 were methicillin-sensitive (MS) and 18 were methicillin-resistant (MR). There was no significant difference in the rate of relapse, catheter removal and death and successful treatment. Patients in the MR group were more likely to change antibiotics during the therapy than MS group (55.6% vs 7.4%, p=0.01) CONCLUSION: Despite a high rate of antibiotic resistance, initial empirical therapy with cefazolin and ceftazidime (or aminoglycoside) based on ISPD guideline is effective as the initial antibiotics choice for gram positive bacterial peritonitis.

Clinical Outcomes of Gram-negative Bacterial Peritonitis / 대한신장학회잡지

BACKGROUND: Peritonitis which is still the most important cause of morbidity and technical failure in peritoneal dialysis even though it has decreased significantly, has been known to lead to different outcomes by the type of causative pathogens. METHODS: To analyze clinical outcomes with trends of peritonitis rates by the type of causative pathogens, we retrospectively reviewed peritoneal dialysis patients in Seoul National University Hospital from 1995 to 2001. RESULTS: Three hundred fifty-seven cases of peritonitis occurred in 163 patients among total 307 peritoneal dialysis patients and the rate of peritonitis was 0.44 episodes/patient-year. There are 130 (38.1 %) episodes of Gram-positive bacterial peritonitis, 59 (17.3%) episodes of Gram-negative bacterial peritonitis and 25 (7.3%) episodes of mixed bacterial peritonitis. E.coli, Acinetobacter, and Pseudomonas were main Gram-negative isolates, in the order named. The rate of total peritonitis and the rate of Gram- positive peritonitis decreased significantly during the study period. But, the rate of Gram-negative peritonitis remained constant, and therefore its relative proportion tended to increase. Among Gram-negative bacteria, the proportion of Pseudomonas species declined persistently. Gram-negative peritonitis was a significant risk factor of hospitalization, independent of soft tissue infection and serum albumin, like S.aureus peritonitis. In Gram-negative peritonitis or Pseudomonas peritonitis, more catheters were removed regardless of soft tissue infection or peritoneal dialysis duration. CONCLUSION: In conclusion, we confirmed Gram- negative peritonitis and Pseudomonas peritonitis have poor prognosis. Therefore, Cautious evaluation of abdominal lesions and aggressive treatment are necessary for patients with Gram-negative peritonitis whose relative proportion increased.

Pulsed Bye Laser Treatment of Anogenital Condyloma Acuminata in a Child / 대한피부과학회지

Condyloma acuminata represent a difficult therapeutic challenge, especially to infants and children who are unable to endure the pain during the treatment process. All the conventional treatments including cryotherapy, CO2 laser ablation cause pain and postoperative scars. It may be traumatic mentally to the infants and children as well as physically. Pulsed dye laser has been introduced as the new treatment of verruca. The results of the pulsed dye laser treatment of verruca have been inconsistent. However, it showed many advantages, such as no need for anesthesia, no destruction of collagen tissue, and the fact that mast patients may remain ambulatory. With the experience of our patient treated by pulsed dye laser, we suggest that pulsed dye laser may be an alternative choice of treatment for condyloma acuminala in children and infants with less pain, no scarring, use of simple anesthesia, less difficulty in management of postoperative wound.

A Case of Multiple Keratoacanthoma with Intralesional 5-FU and Etretinate Therapy / 대한피부과학회지

Keratoacanthoma is a benign epithelial growth tumor arising from the hair follicle predominantly in elderly patients on sun-exposed skin. Intralesional therapy with 5-fluorouracil is a safe treatment and may be the treatment of choice for multiple keratoacanthoma and solitary lesion which are difficult to remove surgically. We have experienced a case of multiple keratoacanthoma which involved the right nasolabial fold and the left ear. We treated them with oral etretinate and intralesional 5-fluorouracil(5-FU), therefore minimized the scar of the lesion and the possibility of recurrence.

A Case of Localized Follicular Hamartoma with Pili Multigemini / 대한피부과학회지

Follicular hamartoma is a rare, benign adnexal tumor with varieties of clinical diversity. But, Histological feature is characterized by a proliferation of immature hair follicle in the dermis with multifocal islands and thickened perifollicular sheath. Pili multigemini is also a rare, developmental anomaly of hair growth with multiple hairs from two or more matrices and papillae in a single pilosebaceous unit. Its prevalence and pathogenesis are unknown. We describe herein a rare case of localized follicular hamartoma with pili multigemini suggesting the possibility of association on pathogenesis between them.

Incidence of Complications of Hysteroscopic surgery & It's safety / 대한산부인과학회잡지

OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.

Incidence of Complications of Hysteroscopic surgery & It's safety / 대한산부인과학회잡지

OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.

Distribution of Histologic Subtypes of Basal Cell Carcinoma by Facial Aesthetic Unit and Subunit / 대한피부과학회지

BACKGROUND: Surgical removal and reconstruction in basal cell carcinoma(BCC) located in the face is important both functionally and cosmetically, however, evaluation of clinical and histological characteristics of BCC in view of dermatologic surgery is not enough. OBJECTIVE: To assess the anatomic distribution of primary and recurrent BCCs, and of histological subtypes based on facial aesthetic units and subunits. And to establish their importance and their application to the dermatologic surgery field. METHODS: We reviewed patients' charts to extract clinical data and reexamined their histologic patterns on the excised specimen, classifying then into 5 categories and mapped the anatomical location of the histologic subtype on schematic drawings of the facial the aesthetic unit and subunit. RESULTS: The location of occurrence in BCCs were on the junctional lines, nose, periorbital area respectively. Of 60 cases occurred in H-zone, 48 cases(80%) occurred in T-zone, and of 9 recurrent cancers occurred in H-zone, 7 cases occurred in T-zone. Among the 5 histologic subtypes, the nodular type was the most common on each of the aesthetic units. And in the junctional lines, the nodular type occurred in almost all cases. The nodulomorpheic type occurred relatively more on forehead, nose and infraorbital area of the cheek. CONCLUSION: We confirmed the relationship between the clinical, histological characteristics and facial aesthetic unit and subunit. And we also proved that T-zone was the most dangerous zone.

Coexistence of Porokeratosis of Mibelli and Disseminated Superficial Actinic Porokeratosis(DSAP)

There have been several reports of more than one type of porokeratosis occurring in the same family or the same individual. We hope to support the view of different phenotypic expressions of a common genetic aberration by describing an additional case of porokeratosis of Mibelli on the perianal area and DSAP on the face, forearms occurring in a 45-year-old man.

A Caes of Trichoblastoma

Trichoblastoma is a rare benign neoplasm that arises in the follicular germinative cells. The terminology and histopathological definition of this tumor is both complex and confusing. Trichoblastoma occurs only on the hair bearing areas such as the scalp, face and pelvic area with varying degrees in size. We describe a case of trichoblastoma occurring as a nodule on the nose. The tumor was composed of numerous lobules of basaloid epithelial cell nests with distinct peripheral palisading of nucleoli that were clearly demarcated from the stroma.

A Caes of Tinea Capitis in an Adult Due to Trichophyton Rubrum

Tinea capitis in adults, especially healthy, is known to be rare but a significant increase in case has recently been observed. Trichophyton rubrum is an anthropophilic, the commonest dermatophyte affecting man but rarely involves the scalp and hair. We describe a 63-year-old healthy woman with tinea capitis due to T. rubrum who has clinical improvement after oral terbinafine therapy.

A Case of Multiple Dermatofibromas in a Healthy Adult

Multiple dermatofibromas are rare and some case reports show this disease has been related to generalized defective immune function: autoimmune disease and altered immunity, such as AIDS and systemic lupus erythematosus(SLE), can be treated with immunosuppressive agents. But there are no specific reports of this disease developing in healthy people. We describe a case of multiple dermatofibromas in a 38-year-old healthy man who showed no abnormality of the immune function.

A Case of Neutrophilic Eccrine Hidradenitis / 대한피부과학회지

Neutrophilic eccrine hidradenitis(NEH) is a self-limited inflammatory dermatosis primarily induced by chemotherapeutic agents. The pathogenesis and possible cause of NEH remain unknown. NEH may represent as a reaction pattern to chemotherapeutic agents or bacterial infection. Also it is developed on palmoplantar areas in healthy children or young adults. In some cases it is developed as a paraneoplastic phenomenon. We report a case of neutrophilic eccrine hidradenitis that developed in a patient suffering from aplastic anemia after or during treatment with cyclosporine, oxymetholone and folic acid.

A Case of Sarecoid Dactylitis / 대한피부과학회지

We report a case of sarcoid dactylitis in which there have been significant bone changes. A 46 year-old female presented with digital erythematous clubbing-like changes and sausage-like swellings of middle phalanges of both hands for 3 months. She had also several freely movable nontender subcutaneous nodules on her trunk and extremities for 3 years. There was a mild leukopenia and decreased cell-mediated immunity. The chest X-ray revealed bilateral hilar lymphadenopathy with increased interstitial lung markings. The X-ray of the hands and feet revealed paraarticular osteolytic lesions and altered trabecular patterns. Histopathologically there were several well-circumscribed granulomas without any caseating necrosis. We treated her with oral prednisone and hydroxychloroquine with some improvement.

A Case of Cutaneous Larva Migrans / 대한피부과학회지

A 34-year-old woman presented with several intensely pruritic erythematous serpiginous thread-like skin lesions which began as a small papule on the epigastrium 4 months prior to her visit and was migrating to the left chest area. The laboratory examination showed eosinophilia and the total serum IgE level was slightly increased. Histopathologic examination revealed a pustular burrow in the epidermis with a larva-like cystic lesion apart from the burrow in the epidermis. The patient was treated with topical 10 % albendazole cream 3 times daily for 1 week without recurrence for 22 months up to now. We thought this was a rare case which was confirmed by a skin biopsy showing larva in the epidermis.