Postoperative effects of bariatric surgery on heart rate recovery and heart rate variability / 고신대학교의과대학학술지

Background@#Several studies have reported associations between obesity and autonomic dysfunction. However, little research has investigated the effect of bariatric surgery on heart rate recovery (HRR) in the treadmill test and heart rate variability (HRV) in 24-hour Holter monitoring. We investigated the effects of bariatric surgery on HRR and HRV, which are parameters related to autonomic dysfunction. @*Methods@#We retrospectively investigated patients who underwent bariatric surgery in 2019. The treadmill test, 24-hour Holter monitoring, and echocardiography were performed before and 6 months after surgery. We compared the changes in HRR in the treadmill test and HRV parameters such as the time domain and spectral domain in 24-hour Holter monitoring before and after surgery. @*Results@#Of the 40 patients who underwent bariatric surgery, 25 patients had the treadmill test or 24-hour Holter monitoring both before and after surgery. Body weight and body mass index significantly decreased after surgery (112.86±24.37 kg vs. 89.10±20.26 kg, p<0.001; 39.22±5.69 kg/m2 vs. 31.00±5.09 kg/m2, p<0.001, respectively). HRR significantly increased (n=23; 43.00±20.97 vs. 64.29±18.49, p=0.001). The time domain of HRV parameters increased (n=21; standard deviation of the N-N interval 123.57±28.05 vs. 152.57±39.49, p=0.002 and mean N-N interval 791.57±88.84 vs. 869.05±126.31, p=0.002). @*Conclusions@#Our data showed that HRR after exercise and HRV during 24-hour Holter monitoring improved after weight reduction with bariatric surgery through improved cardiac autonomic function.

Radioactivity Reduction of 2-Deoxy-2-18F Fluoro-D-Glucose by Milkand Ursodeoxycholic Acid in Preclinical Study / 대한핵의학회잡지

Purpose@#2-Deoxy-2-[18F] fluoro-d-glucose positron emission tomography (18F-FDG-PET) is a less-invasive and widely useddiagnostic tool for detection of malignant tumors. However, prolonged retention of 18F-FDG in the body increases radiationexposure. This study evaluated the effect of oral administration of milk and ursodeoxycholic acid (UDCA) in terms of reducingradiation exposure by 18F-FDG. @*Methods@#18F-FDG radioactivity was measured using a digital γ counter in the whole body and in various organs of rats after oraladministration of milk andmilk plusUDCA (milk + UDCA).Western blotting was performed to measure the expression levels ofG6Pase, HK 2, CREB, FoxO1, and PGC-1α in the brain, liver, small intestine, and large intestine to assess the mechanismunderlying the reduction in radiation exposure from 18F-FDG by oral administration of milk and UDCA. @*Results@#We found a significant reduction in 18F-FDG radioactivity in the whole body and in the brain, liver, and small and largeintestines. Expression of G6Pase was significantly increased in the above-mentioned organs in the milk and milk + UDCAgroups. Expression of HK 2 was significantly decreased in the brain and small intestine in the milk and milk + UDCA groups.CREB, FoxO1, and PGC-1α expression levels in the brain, liver, and small intestine were increased in the milk and milk +UDCA groups. However, expression of PGC-1α in the large intestine in the milk and milk + UDCA groups was significantlydecreased compared with that in the control group. @*Conclusion@#The present study demonstrated that administration of milk and UDCA increased G6Pase expression levels and 18FFDGrelease from the tissue. These results suggest milk and UDCA could be used to reduce radiation exposure from 18F-FDGafter image acquisition. The mechanisms underpinning this phenomenon should be explored in a human study.

An Analysis of the Foot and Ankle-related Questions on the Korean Orthopedic In-Training Examination / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the questions pertaining to the foot and ankle on the Korean Orthopedic In-Training Examination (KOITE) between 2012 and 2016. MATERIALS AND METHODS: Questions regarding the foot and ankle on KOITE during the five-year period (2012∼2016) were analyzed. Number of foot and ankle questions, topics, taxonomic classification, imaging modalities, and cited references related to each question were analyzed. RESULTS: The average number of foot and ankle questions was 35, accounting for 7.0% (35/500) of all KOITE questions. All questions were categorized into three topic areas: disease (51.4%, 18/35), trauma (31.4%, 11/35), and basics (17.1%, 6/35). Taxonomy 3 (decision-making type questions) was the most common (42.9%, 15/35). References that are commonly used for each question were Campbell's Operative Orthopedics (100%, 35/35) and the textbook of The Korean Orthopaedic Association (74.3%, 26/35). CONCLUSION: This analysis can be valuable to not only orthopaedic surgery residents to improve their knowledge of orthopedics, but also to instructors for optimizing their education programs.

Protective Effects of Curcumin on Renal Oxidative Stress and Lipid Metabolism in a Rat Model of Type 2 Diabetic Nephropathy

PURPOSE: Diabetic nephropathy is a serious complication of type 2 diabetes mellitus, and delaying the development of diabetic nephropathy in patients with diabetes mellitus is very important. In this study, we investigated inflammation, oxidative stress, and lipid metabolism to assess whether curcumin ameliorates diabetic nephropathy. MATERIALS AND METHODS: Animals were divided into three groups: Long-Evans-Tokushima-Otsuka rats for normal controls, Otsuka-Long-Evans-Tokushima Fatty (OLETF) rats for the diabetic group, and curcumin-treated (100 mg/kg/day) OLETF rats. We measured body and epididymal fat weights, and examined plasma glucose, adiponectin, and lipid profiles at 45 weeks. To confirm renal damage, we measured albumin-creatinine ratio, superoxide dismutase (SOD), and malondialdehyde (MDA) in urine samples. Glomerular basement membrane thickness and slit pore density were evaluated in the renal cortex tissue of rats. Furthermore, we conducted adenosine monophosphate-activated protein kinase (AMPK) signaling and oxidative stress-related nuclear factor (erythroid-derived 2)-like 2 (Nrf2) signaling to investigate mechanisms of lipotoxicity in kidneys. RESULTS: Curcumin ameliorated albuminuria, pathophysiologic changes on the glomerulus, urinary MDA, and urinary SOD related with elevated Nrf2 signaling, as well as serum lipid-related index and ectopic lipid accumulation through activation of AMPK signaling. CONCLUSION: Collectively, these findings indicate that curcumin exerts renoprotective effects by inhibiting renal lipid accumulation and oxidative stress through AMPK and Nrf2 signaling pathway.

Vav3, a GEF for RhoA, Plays a Critical Role under High Glucose Conditions

BACKGROUND: The role of small GTPase molecules is poorly understood under high glucose conditions. METHODS: We analyzed the expression pattern of Vav3 in skeletal muscle C2C12 cells under high glucose culture condition with reverse transcription-polymerase chain reaction and Western blot analysis. We also measured glucose uptake using isotope-labelled glucose. RESULTS: We showed that expression of Vav3 (a guanine nucleotide exchange factor for RhoA) increased. mRNA and protein levels in skeletal muscle C2C12 cells under high glucose conditions. The AMP-activated protein kinase (AMPK) activator AMPK agonist 5-aminoimidazole-4-carboxy-amide-1-d-ribofuranoside (AICAR) suppressed high glucose-induced Vav3 induction. In addition, exposure of cells to high glucose concentration increased the phosphorylation of PAK-1, a molecule downstream of RhoA. The phosphorylation of paxillin, a downstream molecule of PAK-1, was also increased by exposure to high glucose. Phosphorylation of these molecules was not observed in the presence of AICAR, indicating that AMPK is involved in the RhoA signal pathway under high glucose conditions. Knock down of Vav3 enhances metformin-mediated glucose uptake. Inhibition of AMPK blocked the increases of Vav3 knock down-induced glucose uptake. Metformin-mediated Glut4 translocation was also increased by Vav3 knock-down, suggesting that Vav3 is involved in metformin-mediated glucose uptake. CONCLUSION: These results demonstrate that Vav3 is involved in the process of metformin-mediated glucose regulation.

Insulin Phosphorylates Tyrosine Residue 464 of Tub and Translocates Tubby into the Nucleus in HIRcB Cells

BACKGROUND: The tubby protein has a motif that might be relevant for its action in the insulin signaling pathway. Previous studies have indicated that tubby undergoes phosphorylation on tyrosine residues in response to several stimuli and is known to localize in the nucleus as well as in the plasma membrane. However, the relationship between phosphorylation and nuclear translocation is not well understood. Here, we report that insulin directly phosphorylates tubby, which translocates into the nucleus. METHODS: The effects of insulin on Tubby were performed with Western blot. The immunoprecipitation and confocal microscopy were performed to prove phosphorylation and nuclear translocation. RESULTS: Mutation study reveals that tyrosine residue 464 of tubby gene (Tub) is a phosphorylation site activated by insulin. In addition, major portions of tubby protein in the plasma membrane are translocated into the nucleus after insulin treatment. Tyrosine kinase inhibitor pretreatment blocked insulin-induced tubby translocation, suggesting that phosphorylation is important for nuclear translocation. Moreover, mutant tyrosine residue 464 did not translocate into the nucleus in respond to insulin. These findings demonstrate that insulin phosphorylates tyrosine residue 464 of Tub, and this event is important for insulin-induced tubby nuclear translocation. CONCLUSION: Insulin phosphorylates tyrosine residue 464 of Tub and translocates tubby into the nuclei of HIRcB cells.

Hypoxia induces Wee1 expression and attenuates hydrogen peroxide-induced endothelial damage in MS1 cells

In an oxygen-depleted environment, endothelial cells initiate an adaptive pattern of synthesis, which may enable them to survive hypoxic crises. Using high-resolution two-dimensional gel electrophoresis in conjunction with mass spectroscopy, we obtained a 24 differential display of proteins in the pancreatic endothelial cell line, MS-1, at four time points following induction of hypoxia. The induction of Wee1 under hypoxia was confirmed both at the mRNA and protein levels. The phosphorylation of cell division cycle 2, which is downstream of Wee1, was also increased after hypoxic exposure. In addition, pre-exposure to hypoxia attenuated a decrease in hydrogen peroxide-induced cell number. The induction of bax (a pro-apoptotic protein) and reduction of bcl (an anti-apoptotic protein) after hypoxia stimulus were also attenuated by hypoxic pre-exposure. Moreover, hydrogen peroxide-induced morphologic damage did not appear in the wild-type Wee1-expressing cells. Taken together, our results suggest that Wee1 may have important role in hypoxia-induced pathophysiological situations in endothelial cells.

Tardy Ulnar Nerve Palsy due to Recurrent Dislocation of the Ulnar Nerve after Medial Epicondylar Fracture of the Humerus: A Case Report

Tardy ulnar nerve palsy might develop secondary to nonunion, malunion, or elbow deformity after medial epicondylar fracture of the humerus. We report a case of tardy ulnar nerve palsy following medial epicondylar fracture, treated with excision of bony fragment, neurolysis and relocation of the ulnar nerve.

Differential Methylation Pattern of ID4, SFRP1, and SHP1 between Acute Myeloid Leukemia and Chronic Myeloid Leukemia

To gain insight into the differential mechanism of gene promoter hypermethylation in acute and chronic leukemia, we identified the methylation status on one part of 5'CpG rich region of 8 genes, DAB2IP, DLC-1, H-cadherin, ID4, Integrin alpha4, RUNX3, SFRP1, and SHP1 in bone marrows from acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) patients. Also, we compared the methylation status of genes in AML and CML using methylation-specific PCR (MSP). The frequencies of DNA methylation of ID4, SFRP1, and SHP1 were higher in AML patients compared to those in CML patients. In contrast, no statistical difference between AML and CML was detected for other genes such as DLC-1, DAB2IP, H-cadherin, Integrin alpha4, and RUNX3. Taken together, these results suggest that these methylation-controlled genes may have different roles in AML and CML, and thus, may act as a biological marker of AML.

Differential Methylation Pattern of ID4, SFRP1, and SHP1 between Acute Myeloid Leukemia and Chronic Myeloid Leukemia

To gain insight into the differential mechanism of gene promoter hypermethylation in acute and chronic leukemia, we identified the methylation status on one part of 5'CpG rich region of 8 genes, DAB2IP, DLC-1, H-cadherin, ID4, Integrin alpha4, RUNX3, SFRP1, and SHP1 in bone marrows from acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) patients. Also, we compared the methylation status of genes in AML and CML using methylation-specific PCR (MSP). The frequencies of DNA methylation of ID4, SFRP1, and SHP1 were higher in AML patients compared to those in CML patients. In contrast, no statistical difference between AML and CML was detected for other genes such as DLC-1, DAB2IP, H-cadherin, Integrin alpha4, and RUNX3. Taken together, these results suggest that these methylation-controlled genes may have different roles in AML and CML, and thus, may act as a biological marker of AML.

Secretin induces neurite outgrowth of PC12 through cAMP-mitogen-activated protein kinase pathway

The gastrointestinal functions of secretin have been fairly well established. However, its function and mode of action within the nervous system remain largely unclear. To gain insight into this area, we have attempted to determine the effects of secretin on neuronal differentiation. Here, we report that secretin induces the generation of neurite outgrowth in pheochromocytoma PC12 cells. The expressions of Tau and beta-tubulin, neuronal differentiation markers, are increased upon secretin stimulation. In addition, secretin induces sustained mitogen-activated protein kinase (MAPK) activation and also stimulates the cAMP secretion. Moreover, the neurite outgrowth elicited by secretin is suppressed to a marked degree in the presence of either PD98059, a specific MAPK/ERK kinase (MEK) inhibitor, or H89, a specific protein kinase A (PKA) inhibitor. Taken together, these observations demonstrate that secretin induces neurite outgrowth of PC12 cells through cAMP-MAPK pathway, and provide a novel insight into the manner in which secretin participates in neuritogenesis.

A Clinical Analysis of Endoscopic Thyroid Lobectomy and Comparison with Conventional Thyroid Lobectomy

PURPOSE: A conventional thyroidectomy requires a wide transverse incision on the anterior neck, which can cause significant scaring. We developed an endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure in order to produce better cosmetic results. We reports the clinical analysis of endoscopic thyroid lobectomy and compare the result with those from a conventional thyroid lobectomy. METHOD: From July 2003 and December 2004, 55 consecutive patients with benign thyroid nodules, who underwent endoscopic thyroid lobectomy, and 51 consecutive patients with benign thyroid nodules, who underwent a conventional thyroid lobectomy, were retrospectively reviewed. The preoperative diagnosis of the thyroid nodules was performed using high-resolution ultrasonography and fine- needle aspiration cytology. The clinical results of endoscopic thyroid lobectomy were analyzed and compared with those from a conventional thyroid lobectomy. RESULTS: There were no significant differences between the two groups in terms of the patients' gender, size of tumor, preoperative diagnosis (follicular tumor/adenomatous nodule), postoperative diagnosis (cancer/benign), level of postoperative discomfort, length of hospital stay. The patients who underwent endoscopic thyroidectomy were significantly younger than those underwent conventional thryoidectomy (37.4+/-10.3 years vs. 48.8+/-13.0 years; P<0.001). The operation time for the endoscopic group was significantly longer than that for the conventional group (171.9+/-35.6 min vs. 92.5+/-26.5 min; P<0.001). The length of closed drainage in the endoscopic group was longer than that in the conventional group (2.8+/-0.8 days vs. 1.4+/-1.3 days; P<0.001). However, these factors did not affect the length of the hospital stay, and the number of intraoperative complications. CONCLUSION: Endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure has cosmetic benefits and is a feasible and safe procedure.

IL-4 inhibits proliferation of renal carcinoma cells by increasing the expression of p21WAF1 and IRF-1

Interleukin (IL)-4 inhibits proliferation of several human cancer cell lines in vitro. Although IL-4 is known to regulate proliferation of lymphocytes by modulating p27KIP1 expression, the mechanism involved in the IL-4-induced growth inhibition of nonhematopoietic cancer cells has not been fully elucidated. Previously, we reported that IL-4 suppressed proliferation of human renal cell carcinoma (RCC) cell lines in vitro. Here, we show that IL-4 inhibits cell cycle progression at the G1 phase in Caki-1 cells by increasing the expression of p21WAF1 and interferon regulatory factor (IRF)-1, and decreasing the cyclin dependent kinase (CDK) 2 activity. Up-regulation of p21WAF1 and IRF-1 expression is transcriptional, but independent of p53. The levels of p21WAF1 and IRF-1 proteins were enhanced as early as 1 h after IL-4 treatment. CDK2 activity started to decline at 4 h after IL-4 treatment, and by 24 h, was ~50% of the control. Neither the protein expressions of p27KIP1 and p16INK4a, nor the phosphorylation level of pRb was changed. The importance of p21WAF1 and IRF-1 in the growth inhibition induced by IL-4 was confirmed by antisense oligonucleotide transfection. Both of p21WAF1 and IRF-1 antisense oligonucleotides prevented IL-4-mediated growth inhibition by ~30% compared to the respective sense oligonucleotides. In summary, our study indicated that p21WAF1 and IRF-1 mediate the growth inhibitory effect of IL-4 in human RCC cells.

Dexamethasone differentiates NG108-15 cells through cyclooxygenase1 induction

Cyclooxygenase (COX) is a key enzyme in the conversion of arachidonic acid into prostanoids which participate in various cellular functions including apoptosis, mitogenesis, inflammation, immune modulation and differentiation. Moreover, the synthetic glucocorticoid, dexamethasone has immune modulating and anti-inflammatory effects in vivo. Recently, dexamethasone was found to enhance retinoic acid-induced neuronal differentiation. In this study, we investigated the mechanisms of dexamethasone-mediated neuronal differentiation. Immunoblotting and morphological analysis demonstrated that dexamethasone induced neuronal differentiation through COX 1 induction. This phenomenon was inhibited by indomethacin, a COX inhibitor. In addition, the addition of exogenous prostaglandin E2 (PGE2), a substance produced by the COX-mediated pathway, triggered neurite outgrowth of cells treated with COX inhibitor. Taken together, COX 1 appears to play an important role in dexamethasone-mediated neuronal differentiation.

A Case of Congenital Hepatic Fibrosis Associated with Polycystic Kidney Disease / 대한소화기내시경학회지

Congenital hepatic fibrosis is a developmental abnormality that may appear either sporadically or in a familial form. It is an inherited disease defined pathologically by bands of fibrous tissue within the liver, and is occasionally associated with cystic kidney disease. A 21-year-old woman was admitted to our hospital for evaluation of pancytopenia. She showed esophageal varices, hepatomegaly and splenomegaly, but had normal results on her liver function test. Peripheral stigmata of chronic liver disease such as palmar erythema or spider angioma was not found. Hepatosplenomegaly, polycystic kidney and psoas muscle cyst were detected through an abdominal CT and MRI. The patient is diagnosis was confirmed as congenital hepatic fibrosis using laparoscopic liver biopsy. The first case of congenital hepatic fibrosis associated with polycystic kidney disease in Korea is herein reported.

Clinical Experience of Domestic SDS-2 Extracorporeal Shock Wave Lithotriptor (ESWL) for 315 Urinary Calculi / 대한비뇨기과학회지

Extracorporeal shock wave lithotripsy monotheraphy was performed in 315 urinary stones from 278 patients with the Domestic SDS-2 lithotriptor using C-arm fluoroscopy between December 1991 and December 1994. Of 315 cases, renal stones were 150 cases(47.6%) and ureteral stones 165 cases(36.1%). No regional or general anesthesia was required but parenteral or oral analgesics were required in some patients. Among 315 cases who completed extracorporeal shock wave lithotripsy, the overall success rate of treatment was 90.5% with 92.4% in 5-9 mm, 94.8% in 10-19 mm, 89.7% in 20-29 mm and 61.5% over 30 mm or staghorn stones. Post lithotripsy complications were transient gross hematuria in 17.1%, renal colic in 11.4%, steinstrasse in 4.8%, petechia in 2.9% and fever in 1.9% and these complications were controlled with conservative treatment or repeated session of extracorporeal shock wave lothotropsy, percutaneous nephrodtomy, Double-J stent insertion or ureterolithotomy. We suggest that extracorporeal shock wave lithotripsy monotheraphy with the Domestic SDS-2 lithotriptor was considered to be effective and safe procedure for the initial treatment of urinary stones.

A study on the relation between lip and teeth at smile in old aged Korean / 대한치과보철학회지

No abstract available.

A Treatment of Ipsilateral Shaft Fracture of the Femur and Tibia in Adult / 대한정형외과학회잡지

Twenty-eight cases of fracture of the femur and tibia on the same leg were treated in Pusan Maryknoll Hospital during the period from April 1981 to Jun 1988. We studied all of these patients, divided by five groups according to the method of treatment, with analysis of treatment and end results. The following results were obtained. 1. The incidence of trauma was high in the young man, and most frequent in the third decade (42.9%). 2. The main cause of injuries was traffic accident; 22 patients (78.6%). 3. The common fracture site was middle one-third in femur and tibia respectively. 4. The most common associsted injury was head trauma (9 case). 5. The average healing time of fracture was 20.7 weeks in femur and 22.7 weeks in tibia of group 3, 4, 5. 6. The best results were obtained in cases both fractures stabilized surgically.