Fimasartan Ameliorates Deteriorations in Glucose Metabolism in a High Glucose State by Regulating Skeletal Muscle and Liver Cells

Purpose@#Since diabetes and hypertension frequently occur together, it is thought that these conditions may have a common pathogenesis. This study was designed to evaluate the anti-diabetic function of the anti-hypertensive drug fimasartan on C2C12 mouse skeletal muscle and HepG2 human liver cells in a high glucose state. @*Materials and Methods@#The anti-diabetic effects and mechanism of fimasartan were identified using Western blot, glucose uptake tests, oxygen consumption rate (OCR) analysis, adenosine 5'-triphosphate (ATP) enzyme-linked immunosorbent assay (ELISA), and immunofluorescence staining for diabetic biomarkers in C2C12 cells. Protein biomarkers for glycogenolysis and glycogenesis were evaluated by Western blotting and ELISA in HepG2 cells. @*Results@#The protein levels of phosphorylated 5' adenosine monophosphate-activated protein kinase (p-AMPK), p-AKT, insulin receptor substrate-1 (IRS-1), and glucose transporter type 4 (Glut4) were elevated in C2C12 cells treated with fimasartan. These increases were reversed by peroxisome proliferator-activated receptor delta (PPARδ) antagonist. ATP, OCR, and glucose uptake were increased in cells treated with 200 μM fimasartan. Protein levels of glycogen phosphorylase, glucose synthase, phosphorylated glycogen synthase, and glycogen synthase kinase-3 (GSK-3) were decreased in HepG2 cells treated with fimasartan. However, these effects were reversed following the addition of the PPARδ antagonist GSK0660. @*Conclusion@#In conclusion, fimasartan ameliorates deteriorations in glucose metabolism as a result of a high glucose state by regulating PPARδ in skeletal muscle and liver cells.

Harnessing of Programmed Necrosis for Fighting against Cancers

Chemotherapy has long been considered as one of useful strategies for cancer treatment. It is primarily based on the apoptosis that can selectively kill cancer cells. However, cancer cells can progressively develop an acquired resistance to apoptotic cell death, rendering refractory to chemo- and radiotherapies. Although the mechanism by which cells attained resistance to drug remains to be clarified, it might be caused by either pumping out of them or interfering with apoptotic signal cascades in response to cancer drugs. In case that cancer cells are defective in some part of apoptotic machinery by repeated exposure to anticancer drugs, alternative cell death mechanistically distinct from apoptosis could be adopted to remove cancer cells refractory to apoptosis-inducing agents. This review will mainly deal with harnessing of necrotic cell death, specifically, programmed necrosis and practical uses. Here, we begin with various defects of apoptotic death machinery in cancer cells, and then provide new perspective on programmed necrosis as an alternative anticancer approach.

Retroanastomotic Hernia

Gastric surgery is one of the most frequently performed operations in Korea. Retroanastomotic hernia is a rare complication ingastric surgery. We experienced this hernia and herein report it with a review of the literature. A 69-year-old male patient suffered from periumbilical pain for 3 days. Positive physical findings were tenderness around the umbilicus and decreased bowel sound. Simple abdominal findings revealed a mechanical obstruction. This patient had a history of gastrectomy 13 years prior to admission. At operation field, we were able to find the defect consisting of the transverse mesocolon, stomach, jejunum and retroperituneum. In Korea, since its first report by Petersen, only a few reports about this hernia have been reported. After increased incidence of operations for morbid obesity, reports on retroanstomotic hernia have increased.

Can Gum Chewing Reduce Postoperative Ileus after Open Abdominal Surgery?

PURPOSE: Gum chewing activates chephalic-vagal reflex as in food consumption and increases the release of gastrointestinal hormones which are related with gut motility. The objective of this study was to assess whether it is effective in shortening the time of hospitalization and postoperative ileus. METHODS: Twenty patients who received open abdominal surgery for colon cancer in Gachon University, Gil Hospital were collected. They were further categorized to gum-chewing group (n=10, mean age=52.0 years, range 37 to 70) and control group (n=10, mean age=59.7 years, range 35 to 75) randomly. The patients in the gum-chewing group chewed gum three times a day from the first postoperative AM until the day they began oral intake. The time of gas out was recorded in each group. RESULTS: The mean time of gas out were 2.35 days (SD 1.2) in gum-chewing group and 2.87 days (SD 1.2) in control group (P=0.41). The mean postoperative hospital days were 10.5 days in gum-chewing group and 13.0 days in control group (P=0.23). CONCLUSION: There were no statistically significant results for shortnening of postoperative ileus and hospital day in this study.

The Expressions of CK7, CK20, Vimentin, p53 and Ki-67 in Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: The expressions of Cytokeratin7 (CK7) and CK20 have been studied by a lot of cancer researchers, and these 2 protein markers are often used to find the primary foci of metastatic cancers. There have been numerous studies on vimentin, p53 and Ki-67 as prognostic factors for different cancers. However, it seems that there are a few investigations on the expression of CK7 and CK20 in papillary carcinoma of the thyroid. This study aimed to investigate the expressions of CK7, CK20, vimentin, p53 and Ki-67 in papillary thyroid carcinoma, and we wanted to determine whether the expressions of vimentin, p53, and Ki-67 are related to such prognostic factors as age, the tumor size, nodal metastasis or perithyroidal tissue invasion. METHODS: Paraffin slices of 44 papillary thyroid carcinomas from 44 patients were used for immunohistochemistry with using monoclonal antibody against CK7, CK20, vimentin, p53 and Ki-67. The expressions of CK7, CK20 and vimentin were determined simply by the staining competence, and more than 5% positive cells out of 1,000 cells in a highpowered microscopic view was considered as positive for the p53 and Ki-67 expressions. The expressions of vimentin, p53 and Ki-67 were investigated for their correlation with age, perithyroidal tissue invasion, the size of the tumor and metastasis to the cervical lymph nodes. RESULTS: Total of 44 patients (7 men and 37 women) were examined. The average size of tumor was 1.3 cm, and 28 (63.6%) out of 44 patients had perithyroidal tissue invasion. 29 (65.9%) patients had cervical lymph node metastases. The expression of CK7 was observed in all 44 (100%) patients, but only three (6.8%) among them had the expression of CK20. The expression of vimentin was shown in 43 (97.7%) patients. The expressions of p53 and Ki-67 were seen in 33 (75%) patients and 12 (27.7%) patients, respectively. The expressions of vimentin, p53 and Ki-67 were not significantly related with age (P=1.0, 0.084), perithyroidal tissue invasion (P=1.0, 0.798), the size of the tumor (P=0.234, 0.313) and cervical lymph node metastases (P=0.582, 0.948). CONCLUSION: As expected, papillary thyroid carcinoma showed a CK7(+)/CK20(-) pattern. Further research is needed to find the meaning of the expression of vimentin because it was meaningless analyzing the relationship between the prognostic factors due to fact that 97.7% of the patients had the expression of vimentin. There was no statistically significant relation between the expressions of p53 and Ki-67 and age, the size of thyroid tumor, perithyroidal tissue invasionand cervical lymph node metastasis.

The Significance of Delphian Lymph Node in Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: The Delphian lymph node (DLN) has long beenregarded as a predictor of thyroid malignancy and indicator of advanced disease; however, there are a few published data in relation to the thyroid. Therefore we are to determine the significance of DLN involvement in differentiated papillary carcinoma. METHODS: We prospectively assessed the discovering rate of DLN and the frequency of DLN metastasis in the consecutive patients undergoing total thyroidectomy with central neck node dissection at Endocrine Surgery Department of our hospital. And we assessed whether DLN involvement may predict extensive cervical lymph node disease and other unfavorable prognostic factors. RESULTS: The DLN was separately removed and identified as such in 42 of 164 patients (25.6%), and 9 of 42 patients (21.4%) had DLN metastases. DLN involvement was not associated with larger tumor size (1.8 vs. 1.1 cm), age (41 vs. 46 years), perithyroidal tissue invasion (66.6 vs. 72.7%) and lymphovascular invasion. DLN involvement was highly predictive of central compartment metastasis (sensitivity 100%, specificity 41%), high proportion of metastatic nodes, and moderately suggestive of further disease in the lateral compartment (sensitivity 44%, specificity 92%). CONCLUSION: Although the clinical appearance of the DLN is not an accurate indicator of the presence of thyroid cancer, metastatic involvement of the DLN is an adverse prognostic marker in papillary thyroid cancer. The presence of DLN metastasis in patients with thyroid cancer should alert the surgeon to the high probability of advanced disease and need for paying greater attention to the central and lateral compartment lymph nodes.

Traumatic Abdominal Wall Hernia (TAWH): Repair by using a Prolen Mesh

Traumatic abdominal wall hernia after blunt abdominal trauma is rare. The prevalence of traumatic abdominal wall hernia in published series is approximately 1%. Recently, by the use of computed tomography has increased the number of occult traumatic abdominal wall hernias (TAWH). A 47-year-old woman presented to the emergency room soon after a traffic accident. She was fully conscious and complained of diffuse, dull, abdominal pain. She had a seat belt on at the time of the accident. Initial computed tomography showed that the lower left abdominal wall had a defect and that a part of the small bowel had herniated through the defect. During the operation, we made an incision at the defect site and confirmed the defect. The defect size was about 15x5 cm. The muscle layers were repaired in layers with absorbable sutures. Prolen mesh was layed down and fixed on the site of the repaired muscle defect. After 6 months, hernia had not recurred, and no weakness of the repaired abdominal wall layers was identified. The patient`s postoperative body functions were normal.

The Expression of Heat Shock Protein 60 kDa in Tissues and Cell Lines of Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer has been reported as the most common cancer of women in the United States, Western Europe and Korea and about 210,000 and 10,000 women in United States and Korea every year, respectively are diagnosed with it. Breast cancer is curable with an early diagnosis, and many researchers have made efforts to find a marker for this malady, heat shock protein (HSP) consists of 6 groups, it is highly preserved throughout both the prokaryotic and eukaryotic cells and it acts as a molecular chaperone that's involved in protein folding. HSPs have been recently reported to be related with breast cancer. In this study, we investigated the changes of expression of HSP60 in tissues and cell lines of breast cancer. METHODS: We obtained breast cancer tissues and normal tissues from breast cancer patients, and we purchased several cancer cell lines from American tissue culture correction. We treated the tissues and the cell lines of human breast cancer with heat shock protein. Proteins and mRNAs were isolated from the tissues and the cells and then we performed Western blotting, reverse transcriptase-Polymerase chain Reaction and fluorescence activated cell sorter analysis on them. RESULTS: On Western blot, HSP60 was more overexpressed in the tissues and the cell lines of breast cancer than in the normal breast tissues and cell lines. The expression of HSP60 showed 2 types of molecular weight differences in the tissues and cell lines of breast cancer, and specifically, low HSP60 was over-expressed in the cancer tissues. There was no difference between the breast cancer cell lines and the normal cell lines in the expressions of HSP60 mRNA, according to the treatment with heat shock. Also, there was no relationship between phosphorylation and the structural difference of HSP60 protein, according to HSP60 protein's molecular weight. The expression of HSP60 has been mostly reported at the mitochondria; however, in this study, it was more predominantly detected at the cytoplasm than at the mitochondria in the breast cancer cell lines. CONCLUSION: We conclude that HSP60 may be used as a diagnostic marker for breast cancer. Detailed investigation of the usefulness and significance of the HSP60 expression as a prognostic factor is required in further studies.

Appendiceal Mucocele

Appendiceal mucocele is a cystic dilatation of the appendiceal lumen with mucus, which may be caused by either benign or malignant diseases. In this report, five cases of appendiceal mucocele are reported, three of which had a preoperative diagnosis of mucocele, whereas the others were found incidentally during the operation under the diagnosis of intussusception and periappendiceal abscess. All five patients underwent surgical resections, including one ileocecal resection and four right hemicolectomies. Histopathology revealed a mucinous cystadenoma in four cases, and a mucinous cystadenocarcinoma in one. There was no disease-related death during 18 months of follow-up.