Phenolic compounds, antioxidant capacity, and α-amylase and α-glucosidase inhibitory activity of ethanol extracts of perilla seed meal.

Perilla frutescens is a medicinal herb that is commonly cultivated in Asian countries. Perilla seed is extensively pressed for cooking oil extraction. However, phenolic chemicals are still abundant in pressed perilla seed meal (PSM), which was previously thought to be useless after oil extraction. In our study, PSM was extracted using five solvents (water and 25%, 50%, 75%, and 100% ethanol) based on different ethanol concentrations, and its antioxidant activity, phenolic compounds, and inhibitory effects against key enzymes related to diabetes mellitus were evaluated. The 75% ethanol extract had higher phenolic (105.58 mg GAE/g DW) and flavonoid (66.52 mg QE/g DW) contents and showed better antioxidant and inhibitory effects against α-glucosidase and α-amylase. Analysis of the phenolic compounds of the five extracts by HPLC indicated the presence of apigenin, rosmarinic acid, benzoic acid, caffeic acid, and vanillic acid. Therefore, because of its high antioxidant activity and inhibitory capacity against enzymes relevant to diabetes, the 75% ethanol extract of perilla seed meal has the most potential to be used as a functional or nutraceutical food in the prevention and treatment of oxidation and diabetes.

Persicae Semen Promotes Bone Union in Rat Fractures by Stimulating Osteoblastogenesis through BMP-2 and Wnt Signaling.

Fractures cause extreme pain to patients and impair movement, thereby significantly reducing their quality of life. However, in fracture patients, movement of the fracture site is restricted through application of a cast, and they are reliant on conservative treatment through calcium intake. Persicae semen (PS) is the dried mature seeds of Prunus persica (L.) Batsch, and in this study the effects of PS on osteoblast differentiation and bone union promotion were investigated. The osteoblast-differentiation-promoting effect of PS was investigated through alizarin red S and Von Kossa staining, and the regulatory role of PS on BMP-2 (Bmp2) and Wnt (Wnt10b) signaling, representing a key mechanism, was demonstrated at the protein and mRNA levels. In addition, the bone-union-promoting effect of PS was investigated in rats with fractured femurs. The results of the cell experiments showed that PS promotes mineralization and upregulates RUNX2 through BMP-2 and Wnt signaling. PS induced the expression of various osteoblast genes, including Alpl, Bglap, and Ibsp. The results of animal experiments show that the PS group had improved bone union and upregulated expression of osteogenic genes. Overall, the results of this study suggest that PS can promote fracture recovery by upregulating osteoblast differentiation and bone formation, and thus can be considered a new therapeutic alternative for fracture patients.

Physicochemical properties and antioxidant activity of colored peppers (Capsicum annuum L.).

Peppers are spices consumed all around the world. This study evaluated the physicochemical properties and antioxidant activities of red, orange, yellow, green, and purple peppers. Total capsaicinoids showed the highest concentration in the green pepper (2416.50 µg/g). Vitamin C showed similar concentrations in all peppers (28.90-30.95 mg/g), except for the purple pepper (25.59 mg/g). Chlorophyll was abundant in the green and the purple peppers (280.36 and 102.13 mg/100 g). Total carotenoid was abundant in the red and the orange peppers (237.04 and 276.94 mg/100 g). Total anthocyanin was detected only in the purple pepper (67.13 mg/100 g). Total flavonoid showed a high concentration in the green and the purple peppers (24.27 and 22.27 CAE mg/g). The yellow pepper showed the highest antioxidant activity according to total polyphenol, DPPH radical scavenging activity, ABTS radical scavenging activity and reducing power assays. Therefore, peppers showed potential for the development of functional food materials.

Generation of Induced Pluripotent Stem Cells from Lymphoblastoid Cell Lines by Electroporation of Episomal Vectors.

Background and Objectives: Lymphoblastoid cell lines (LCLs) deposited from disease-affected individuals could be a valuable donor cell source for generating disease-specific induced pluripotent stem cells (iPSCs). However, generation of iPSCs from the LCLs is still challenging, as yet no effective gene delivery strategy has been developed. Methods and Results: Here, we reveal an effective gene delivery method specifically for LCLs. We found that LCLs appear to be refractory toward retroviral and lentiviral transduction. Consequently, lentiviral and retroviral transduction of OCT4, SOX2, KFL4 and c-MYC into LCLs does not elicit iPSC colony formation. Interestingly, however we found that transfection of oriP/EBNA-1-based episomal vectors by electroporation is an efficient gene delivery system into LCLs, enabling iPSC generation from LCLs. These iPSCs expressed pluripotency makers (OCT4, NANOG, SSEA4, SALL4) and could form embryoid bodies. Conclusions: Our data show that electroporation is an effective gene delivery method with which LCLs can be efficiently reprogrammed into iPSCs.

Navigation Path Based Universal Mobile Manipulator Integrated Controller (NUMMIC).

As the demand for service robots increases, a mobile manipulator robot which can perform various tasks in a dynamic environment attracts great attention. There are some controllers that control mobile platform and manipulator arm simultaneously for efficient performance, but most of them are difficult to apply universally since they are based on only one mobile manipulator model. This lack of versatility can be a big problem because most mobile manipulator robots are made by connecting a mobile platform and manipulator from different companies. To overcome this problem, this paper proposes a simultaneous controller which can be applied not only to one model but also to various types of mobile manipulator robots. The proposed controller has three main characteristics, which are as follows: (1) establishing a pose that motion planning can be carried out in any position, avoiding obstacles and stopping in a stable manner at the target coordinates, (2) preventing the robot from collision with surrounding obstacles while driving, (3) defining a safety area where the manipulator does not hit the obstacles while driving and executing the manipulation accordingly. Our controller is fully compatible with Robot Operating System (ROS) and has been used successfully with three different types of mobile manipulator robots. In addition, we conduct motion planning experiments on five targets, each in two simulation worlds, and two motion planning scenarios using real robots in real-world environments. The result shows a significant improvement in time compared to existing control methods in various types of mobile manipulator and demonstrates that the controller works successfully in the real environment. The proposed controller is available on GitHub.

Changes in the Physicochemical Properties, Antioxidant Activity and Metabolite Analysis of Black Elephant Garlic (Allium ampeloprasum L.) during Aging Period.

This study investigated the effects of the aging period on the black elephant garlic (Allium ampeloprasum L.) manufacturing process. Black elephant garlic is a processed elephant garlic product prepared by high-temperature and high-humidity treatment for 40 days. The proximate composition (moisture, crude lipid, crude protein, carbohydrate, and ash), minerals, color values, reducing sugars, pH, total polyphenol contents, total flavonoid contents and antioxidant activities of elephant garlic and black elephant garlic were evaluated. The browning intensity of elephant garlic increased with the aging period, but the browning reaction terminated after aging for 30 days, exhibiting the same browning level. Reducing sugars increased over the aging period until 20 days, and then decreased with the aging period, in contrast to the pH, which decreased from 6.47 to 3.68 over the aging period. Antioxidant components, including the total polyphenol and total flavonoid contents of black elephant garlic, increased significantly until day 30 of aging. From the metabolite profiles determined through GC/MS analysis, it was confirmed that primary metabolites related to antioxidant components, such as lactic acid and 5-hydroxymethyl-2-furoic acid, were generated during the aging process of elephant garlic.

Shift of Dominant Species in Plant Community and Soil Chemical Properties Shape Soil Bacterial Community Characteristics and Putative Functions: A Case Study on Topographic Variation in a Mountain Pasture.

Reducing management intensity according to the topography of pastures can change the dominant plant species from sown forages to weeds. It is unclear how changes in species dominance in plant community drive spatial variation in soil bacterial community characteristics and functions in association with edaphic condition. Analysing separately the effects of both plant communities and soil chemical properties on bacterial community is crucial for understanding the biogeographic process at a small scale. In this paper, we investigated soil bacterial responses in five plant communities (two forage and three weed), where >65% of the coverage was by one or two species. The structure and composition of the bacterial communities in the different microbiome were analysed using sequencing and their characteristics were assessed using the Functional Annotation of Prokaryotic Taxa (FAPROTAX) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Firmicutes and Planctomycetes responded only to one specific plant community, and each plant community harboured unique operational taxonomic units (OTUs) at the species level. There were a large percentage of uniquely absent OTUs for specific plant communities, suggesting that a negative effect is critical in the relationship between plants and bacteria. Bacterial diversity indices were influenced more by soil chemical properties than by plant communities. Some putative functions related to C and N recycling including nitrogen fixation were correlated with pH, electrical conductivity (EC) and nutrient levels, and this also implied that some biological functions, such as ureolysis and carbon metabolism, may decline when fertilisation intensity is reduced. Taken together, these results suggest that a shift of dominant species in plant community exerts individual effects on the bacterial community composition, which is different from the effect of soil chemical properties.

Transcortical Endoscopic Surgery for Intraventricular Lesions.

To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched using the keywords 'endoscopy,' 'endoscopic,' and 'neuroendoscopic.' Of these articles, those describing intraventricular lesions were reviewed. Suprasellar arachnoid cysts (SACs) can be treated with ventriculo-cystostomy (VC) or ventriculo-cysto-cisternostomy (VCC). VCC showed better results compared to VC. Procedure type, fenestration size, stent placement, and aqueductal patency may affect SAC prognosis. Colloid cysts can be managed using a transforaminal approach (TA) or a transforaminal-transchoroidal approach (TTA). However, TTA may result in better exposure compared to TA. Intraventricular cysticercosis can be cured with an endoscopic procedure alone, but if pericystic inflammation and/or ependymal reaction are seen, third ventriculostomy may be recommended. Tumor biopsies have yielded successful diagnosis rates of up to 100%, but tumor location, total specimen size, endoscope type, and vigorous coagulation on the tumor surface may affect diagnostic accuracy. An ideal indication for tumor excision is a small tumor with friable consistency and little vascularity. Tumor size, composition, and vascularity may influence a complete resection. SACs and intraventricular cysticercosis can be treated successfully using endoscopic procedures. Endoscopic procedures may represent an alternative to surgical options for colloid cyst removal. Solid tumors can be safely biopsied using endoscopic techniques, but endoscopy for tumor resection still results in considerable challenges.

Echo-Doppler-derived indexes of ventricular stiffness and ventriculo-arterial interaction as predictors of new-onset atrial fibrillation in patients with heart failure.

BACKGROUND: Atrial fibrillation (AF) is common in patients with heart failure (HF) and worsens their prognosis. Vulnerability to changes in loading is an important factor in the development of AF and is strongly influenced by ventricular stiffness and ventriculo-arterial interaction. The aim of this study was to investigate predictors of AF development in patients with HF. METHODS: We studied 349 patients with stable HF. The following parameters of ventricular stiffness and ventriculo-arterial interaction were derived from echo-Doppler measurements: left ventricular (LV) diastolic elastance (Ed), effective arterial elastance (Ea), LV end-systolic elastance (Ees) and ventricular-vascular coupling index (VVI). RESULTS: AF occurred in 57 (16.3%) patients over a median follow up of 30.3 months. Echo-Doppler-derived parameters of ventricular stiffness and ventriculo-arterial interaction were closely associated with HF severity. Ed was independently associated with AF after adjustment for age, hypertension, diabetes mellitus, and left atrial volume index (hazard ratio [HR] 5.49, p = 0.018). Ea and VVI were also associated with new-onset AF (HR 1.66, p = 0.027, and HR 1.06, p = 0.001, respectively). CONCLUSIONS: Echo-Doppler indexes of ventricular stiffness are closely associated with HF severity. LV diastolic elastance (Ed) is the strongest predictor of new-onset AF in HF patients.

Anti-Diabetic and Hepato-Renal Protective Effects of Ziyuglycoside II Methyl Ester in Type 2 Diabetic Mice.

Type 2 diabetes is a metabolic disorder caused by abnormal carbohydrate metabolism, and closely associated with abnormal lipid metabolism and hepato-renal dysfunction. This study investigated the anti-diabetic and hepato-renal protective properties of ziyuglycoside I (ZG01) derivative on type 2 diabetes. ZG01 was isolated from roots of Sanguisorba officinalis and chemically modified by deglycosylation and esterification to obtained ziyuglycoside II methyl ester (ZG02-ME). Here, we showed that ZG02-ME has stronger anti-diabetic activity than the original compound (ZG01) through decreasing blood glucose, glycated hemoglobin (HbA1c), and insulin levels in a mouse model of type 2 diabetes (db/db mice). We further found that ZG02-ME treatment effectively ameliorated serum insulin, leptin and C-peptide levels, which are key metabolic hormones, in db/db mice. In addition, we showed that elevated basal blood lipid levels were decreased by ZG02-ME treatment in db/db mice. Furthermore, treatment of ZG02-ME significantly decreased serum AST, ALT, BUN, creatinine, and liver lipid peroxidation in db/db mice. These results demonstrated that compared to ZG01, chemically modified ZG02-ME possess improved anti-diabetic properties, and has hepato-renal protective activities in type 2 diabetes.

Anomalous rapid defect annihilation in self-assembled nanopatterns by defect melting.

Molecular self-assembly commonly suffers from dense structural defect formation. Spontaneous defect annihilation in block copolymer (BCP) self-assembly is particularly retarded due to significant energy barrier for polymer chain diffusion and structural reorganization. Here we present localized defect melting induced by blending short neutral random copolymer chain as an unusual method to promote the defect annihilation in BCP self-assembled nanopatterns. Chemically neutral short random copolymer chains blended with BCPs are specifically localized and induce local disordered states at structural defect sites in the self-assembled nanopatterns. Such localized "defect melting" relieves the energy penalty for polymer diffusion and morphology reorganization such that spontaneous defect annihilation by mutual coupling is anomalously accelerated upon thermal annealing. Interestingly, neutral random copolymer chain blending also causes morphology-healing self-assembly behavior that can generate large-area highly ordered 10 nm scale nanopattern even upon poorly defined defective prepatterns. Underlying mechanisms of the unusual experimental findings are thoroughly investigated by three-dimensional self-consistent field theory calculation.

Extent of disc degeneration after single-level cervical anterior microforaminotomy analyzed with long-term radiological data.

OBJECTIVE: To prove the extents and details of cervical degeneration after anterior microforaminotomy (AMF) with 6-years follow-up. METHODS: A retrospective study of 24 patients, underwent single-level AMF, was performed. Clinical and radiologic data were analyzed with office charts, questionaires, and picture achieving and communication system images. RESULTS: According to Odom's criteria, 91.6% achieved favorable outcome. The mean visual analog scale score was improved from 8.6 to 3, and the mean neck disability index was improved from 27.9 to 7.3 (p<0.01). Eighteen cases (75%) showed disc height (DH) decrease. The disc invasion was correlated with DH decrease (p<0.05). The disc height decrease correlated with static, dynamic changes of shell angle and spur formation (p<0.05). Any radiological parameters did not affect the clinical outcome. CONCLUSION: AMF is an effective technique for treating unilateral cervical radiculopathy. It showed excellent surgical outcomes even in long-term follow-ups. However, a decrease in DH occurred in a considerable number of patients. Disc invasion during surgery may be the trigger of sequential degeneration.

Lipoprotein-associated phospholipase A2 is related to plaque stability and is a potential biomarker for acute coronary syndrome.

PURPOSE: Plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) binds to low-density lipoprotein. The levels of Lp-PLA2 reflect the plaque burden, and are upregulated in acute coronary syndrome (ACS). We investigated the diagnostic value of Lp-PLA2 levels and found that it might be a potential biomarker for ACS. MATERIALS AND METHODS: We classified 226 study participants into three groups: patients without significant stenosis (control group), patients with significant stenosis with stable angina (SA group), and patients with ACS (ACS group). RESULTS: Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) levels were significantly greater in the ACS group than in the SA group (p=0.044 and p=0.029, respectively). Multivariate logistic regression analysis revealed that Lp-PLA2 levels are significantly associated with ACS (odds ratio=1.047, p=0.013). The addition of Lp-PLA2 to the ACS model significantly increased the global χ² value over traditional risk factors (28.14 to 35.602, p=0.006). The area under the receiver operating characteristic curve for Lp-PLA2 was 0.624 (p=0.004). The addition of Lp-PLA2 level to serum hs-CRP concentration yielded an integrated discrimination improvement of 0.0368 (p=0.0093, standard error: 0.0142) and improved the ability to diagnose ACS. CONCLUSION: Lp-PLA2 levels are related to plaque stability and might be a diagnostic biomarker for ACS.

MicroRNA-365 inhibits the proliferation of vascular smooth muscle cells by targeting cyclin D1.

Abnormal proliferation of vascular smooth muscle cells (VSMCs) is a common feature of disease progression in atherosclerosis. Cell proliferation is regulated by cell cycle regulatory proteins. MicroRNAs (miR) have been reported to act as important gene regulators and play essential roles in the proliferation and migration of VSMCs in a cardiovascular disease. However, the roles and mechanisms of miRs in VSMCs and neointimal formation are far from being fully understood. In this study, cell cycle-specific cyclin D1 was found to be a potential target of miR-365 by direct binding. Through an in vitro experiment, we showed that exogenous miR-365 overexpression reduced VSMC proliferation and proliferating cell nuclear antigen (PCNA) expression, while miR-365 was observed to block G1/S transition in platelet-derived growth factor-bb (PDGF-bb)-induced VSMCs. In addition, the proliferation of VSMCs by various stimuli, including PDGF-bb, angiotensin II (Ang II), and serum, led to the downregulation of miR-365 expression levels. The expression of miR-365 was confirmed in balloon-injured carotid arteries. Taken together, our results suggest an anti-proliferative role for miR-365 in VSMC proliferation, at least partly via modulating the expression of cyclin D1. Therefore, miR-365 may influence neointimal formation in atherosclerosis patients.

Clinical and radiological long-term outcomes of anterior microforaminotomy for cervical degenerative disease.

STUDY DESIGN: A retrospective review. OBJECTIVE: To evaluate the long-term clinical and radiological results after anterior microforaminotomy (AMF), with details of postoperative degeneration. SUMMARY OF BACKGROUND DATA: AMF is an alternative procedure to treat unilateral cervical radiculopathy. Although previous clinical results are favorable, degeneration may occur after surgery. However, the details of this have not been proven. METHODS: A total of 154 AMF procedures in 135 patients were performed. Of these, 82 patients (97 AMF) had complete preoperative and minimum 3-year postoperative clinical outcomes data available for analysis. Radiological data were analyzed with picture achieving communication system images. Long-term clinical results were accessed by a questionnaire and telephone interviews. Clinical and radiological parameters were statistically analyzed. RESULTS: Spondylosis comprised 53.7%, disc herniation comprised 36%, and mixed comprised 10.3%. The mean age was 49 (range, 31-76) years. Operated levels were 1 level in 71 patients, 2 in 10, and 3 in 1. Reoperation was performed in 2 patients (2.4%). The mean follow-up was 6.1 years. A total of 90.3% achieved an excellent or good outcome. Visual analogue scale scores improved from 8.2 (6-10) to 2.9 (0-10), and neck disability index scores improved from 24.5 (7-46) to 6.7 (0-31) (P < 0.05). Eighty-one cases (83.5%) showed a decrease in disc height (DH), with 1 mm of the mean. The DH decrease was positively correlated with disc invasion (P < 0.01) and AMF diameter (P < 0.01). According to statistical analysis, the critical AMF diameter was 4.7 mm. Anterior spur formation occurred in 39 cases (40.2%). No radiological parameters affected the clinical outcome. CONCLUSION: AMF is a safe, effective procedure to treat unilateral cervical radiculopathy. Critical DH decreases may be the trigger of sequential degeneration. To preserve DH, disc invasion must be avoided, and AMF must be made as small as possible with exact removal of compressive lesion. LEVEL OF EVIDENCE: 4.

Diverse left ventricular morphology and predictors of short-term outcome in patients with stress-induced cardiomyopathy.

BACKGROUND: There is paucity of data with regard to the clinical spectrum according to left ventricle (LV) morphological variation in stress-induced cardiomyopathy (SCMP) patients, and still there is controversy in terms of prognosis since some people believe that the published in-hospital mortality data of patients with SCMP are underestimated. Therefore, we sought to investigate the morphological features of LV and in-hospital outcome of patients with SCMP and explored predictors of short-term prognosis. METHODS: This was a multicenter, observational study of 208 SCMP patients. Morphological features of LV were determined by echocardiography and were divided into typical (apical) and atypical ballooning types, which were subcategorized into mid-LV ballooning and basal 'inverted' ballooning type. All-cause mortality of patients with SCMP during hospitalization was recorded. RESULTS: The apical ballooning type was most common (67.3%) in SCMP followed by the mid-LV ballooning type (28.3%), and the basal 'inverted' ballooning type (4.3%). There were no differences in stressor types and in-hospital mortality between patients with typical and atypical SCMP. Notably, all the in-hospital mortality of SCMP patients occurred in patients with physical stressors, where age, shock, and LV ejection fraction were the independent risk factors for predicting in-hospital mortality. CONCLUSIONS: SCMP patients showed diverse patterns of LV morphology, but there were no definite differences on clinical spectrum among SCMP patients presenting various LV morphological patterns. In terms of short-term prognosis, underlying physical conditions combined with old age, hemodynamic compromise, and low LV systolic function might be the most important factors in SCMP patients.

Psychological impact of health risk appraisal of Korean women at different levels of breast cancer risk: neglected aspect of the web-based cancer risk assessment tool.

OBJECTIVE: Health risk appraisal is often utilized to modify individual's health behavior, especially concerning disease prevention, and web-based health risk appraisal services are being provided to the general public in Korea. However, little is known about the psychological effect of the health risk appraisal even though poorly communicated information by the web-based service may result in unintended adverse health outcomes. This study was conducted to explore the psychological effect of health risk appraisal using epidemiological risk factor profile. METHODS: We conducted a randomized trial comparing risk factor list type health risk appraisal and risk score type health risk appraisal. We studied 60 women aged 30 years and older who had no cancer. Anxiety level was assessed using the Spielberger State-Trait Anxiety Inventory YZ. RESULTS: The results of multivariate analysis showed that risk status was the independent predictors of increase of state anxiety after health risk appraisal intervention when age, education, health risk appraisal type, numeracy, state anxiety, trait anxiety, and health risk appraisal type by risk status interaction was adjusted. Women who had higher risk status had an odd of having increased anxiety that was about 5 times greater than women who had lower risk status. CONCLUSIONS: Our findings indicate that communicating the risk status by individual health risk appraisal service can induce psychological sequelae, especially in women having higher risk status. Hospitals, institutes, or medical schools that are operating or planning to operate the online health risk appraisal service should take side effects such as psychological sequelae into consideration.

Community-based intervention to promote breast cancer awareness and screening: the Korean experience.

BACKGROUND: There are many differences in culture, community identity, community participation, and ownership between communities in Western and Asian countries; thus, it is difficult to adopt the results of community intervention studies from Western countries. In this study, we conducted a multicity, multicomponent community intervention trial to correct breast cancer myths and promote screening mammography for women living in an urban community in Korea. METHODS: A 6-month, 2-city community intervention trial was conducted. In the intervention city, 480 women were surveyed at baseline and 7 months later to evaluate the effects of the intervention program. Strategies implemented in the intervention city included community outreach and clinic and pharmacy-based in-reach strategies. RESULTS: This study showed a 20.4-percentage-point decrease in myths about the link between cancer and breast size, a 19.2-percentage-point decrease in myths concerning mammography costs, and a 14.1-percentage-point increase in intention to undergo screening mammography. We also saw a 23.4-percentage-point increase in the proportion of women at the action stage of the transtheoretical model in the intervention city. In the comparison city, smaller decreases and increases were observed. CONCLUSIONS: Our study showed the value of an intervention study aimed at reducing belief in breast cancer myths in an urban community in Korea. The invention also made women more likely to undergo mammography in future.

Attitude and knowledge of physicians about cancer pain management: young doctors of South Korea in their early career.

OBJECTIVE: This study is aimed at evaluating the attitude and knowledge about the optimal use of opioids and finding out the barriers to cancer pain management especially for young doctors in South Korea. METHODS: A survey through questionnaire form was conducted on 1204 physicians. Physicians were grouped by their medical specialties and personal characteristics. Specialties were grouped into internal medicine and family medicine doctors, surgeons, anesthesiologists, pediatricians, other board holders and general physicians. Personal characteristics were grouped by their past experiences and current surroundings. RESULTS: Though many doctors thought that they were fairly well educated for pain management strategy, a large population of physicians showed a negative attitude and inadequate knowledge status about cancer pain management. The degree of attitude and knowledge status was different as their specialties and personal experiences. The factors that affected doctors' attitude and knowledge were: (i) medical specialty, (ii) past history of using practical pain assessment tool, (iii) self-perception of knowledge status about pain management, (iv) experience of prescribing opioids, (v) experience of education for cancer pain management. Although many physicians had a passive attitude in prescribing opioid analgesics, they are willingly open to use opioids for cancer pain management in the future. The most important perceived barriers to optimal cancer pain management were the fear for risk of tolerance, drug addiction, side effects of opioid analgesics and knowledge deficit about opioid analgesics. CONCLUSIONS: From this study, we found that further education and practical training will be needed for adequate cancer pain management for young physicians in their early career.

Endoscopic management of cranial arachnoid cysts using extra-channel method.

OBJECTIVE: Arachnoid cysts (ACs) can be cured by making the definite and wide communication between the cyst and arachnoid space using endoscopy, but often it is impossible only through the usual working-channel (intra-channel) procedures. We discuss and propose a more valuable endoscopic technique with the presentation of our series of cases. METHODS: We treated 9 patients with cortical AC in various locations with extra-channel endoscopic techniques. The patients ranged in age from 3 years to 60 years (mean age, 37.2 yrs). The follow-up period ranged from 12 to 26 months (mean follow-up duration, 17.2 months). All patients had large AC compressing the adjacent brain with clinical symptoms or signs. The authors performed extensive fenestration via single burr hole with the aid of endoscope. Being bypassed the rigid endoscope, through the space between the shaft of endoscope and guiding cannula (extra-channel method), fenestration procedures were done in the dry fields. RESULTS: Eight (88.9%) patients had been treated successfully with endoscope. One patient required shunt procedure. Among the eight patients who were treated with endoscopic procedure, 6 patients (66.7%) showed cyst reduction, and two (22.2%) showed disappearance of cyst. CONCLUSION: We suggest that extra-channel method will be simple and easy to perform using more valuable instruments with wider working area, and may promise better results compared to the conventional intra-channel endoscopic procedures.