Cytokine changes in newborns with therapeutic hypothermia after hypoxic ischemic encephalopathy.

OBJECTIVE: This study aimed to examine changes in cytokines according to therapeutic hypothermia (TH) for newborn hypoxic ischemic encephalopathy (HIE). STUDY DESIGN: We studied 20 neonates who were admitted with a diagnosis of HIE in the neonatal intensive care unit. Cytokine concentration assay was carried out for neonates (n=12) who received TH and neonates (n=8) who were not treated with hypothermia by collecting blood sample at 12, 48 and 120 h after birth. RESULTS: At 48 h after birth, interleukin (IL)-6 in the normothermia group was higher than that in the hypothermia group (P=0.010). At 48 h after birth, IL-10 was higher in the hypothermia group than in the normothermia group (P=0.038). CONCLUSION: This study confirmed that TH performs a role in the prevention of inflammatory process by way of maintaining proinflammatory cytokine IL-6 at low levels and anti-inflammatory cytokines IL-10 at high levels.

Cell population data in neonates: differences by age group and associations with perinatal factors.

INTRODUCTION: Cell population data (CPD) describe physical parameters of white blood cell subpopulations and are reported to be of some value in the diagnosis of sepsis in neonates. Before using the CPD for diagnosing sepsis, the baseline features of the CPD distribution in healthy neonates should be clarified. The aim of this study was to compare the CPD distributions of healthy neonates and other age groups and to identify perinatal factors that are associated with changes in the CPD distribution of healthy neonates. METHODS: The CPD distribution of 69 samples from term neonates was compared with adolescents and adults. The CPD distribution of 163 samples from healthy neonates was analyzed in association with perinatal factors, including gestational age, chronologic age, birthweight, delivery mode, premature rupture of membranes, diabetes, and pregnancy-induced hypertension. RESULTS: The CPD distribution for term neonates was significantly different from those in adolescents and adults. The mean lymphocyte volume showed a negative correlation with gestational age at birth (r = -0.305; P < 0.01). The mean neutrophil volume was smaller in the cesarean section group than in the normal delivery group. The small for gestational age (SGA) group had smaller mean neutrophil volume and mean monocyte volume than the appropriate for gestational age group. CONCLUSION: The CPD distribution of healthy neonates differed from those of adolescents or adults, and the differences were associated with gestational age, delivery mode, and being SGA.

Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring.

Nonvariceal upper gastrointestinal (UGI) bleeding recurs after appropriate endoscopic therapy in 10 % - 15 % of cases. The mortality rate can be as high as 25 % when bleeding recurs, but there is no consensus about the best modality for endoscopic re-treatment. The aim of this study was to evaluate clipping and detachable snaring (CDS) for rescue endoscopic control of nonvariceal UGI hemorrhage. We report a case series of seven patients from a Korean tertiary center who underwent endoscopic hemostasis using the combined method of detachable snares with hemoclips. The success rate of endoscopic hemostasis with CDS was 86 %: six of the seven patients who had experienced primary endoscopic treatment failure or recurrent bleeding after endoscopic hemostasis were treated successfully. In conclusion, rescue endoscopic bleeding control by means of CDS is an option for controlling nonvariceal UGI bleeding when no other method of endoscopic treatment for recurrent bleeding and primary hemostatic failure is possible.

The efficacy of i-SCAN for detecting reflux esophagitis: a prospective randomized controlled trial.

New imaging technologies have been applied in endoscopy to improve the detection and differentiation of subtle mucosal changes using a digital contrast method. Among them, i-SCAN technology is the most recently developed image-enhancing technology. We investigated whether i-SCAN could improve the detection rate of reflux esophagitis. Interobserver agreement between endoscopists was compared with conventional white light (WL) endoscopic examination. We performed a prospective randomized controlled trial. A consecutive series of 514 subjects that underwent an esophagogastroduodenoscopy for health inspection were enrolled and randomized into the i-SCAN group (n = 246) and WL group (n = 268). An esophagogastroduodenoscopy with video recording was used for detecting reflux esophagitis, and reflux esophagitis were categorized by the modified Los Angeles (LA) classification. The total number of reflux esophagitis identified by WL and i-SCAN was 58 (21.7%) and 74 (30.1%), respectively. The diagnostic yield of reflux esophagitis was significantly higher (P = 0.034) in the i-SCAN group (30.1%) as compared to the WL group (21.6%). Using the modified LA classification, the detection rate of minimal changes was significantly higher (P = 0.017) in the i-SCAN group (11.8%) as compared to the WL group (5.6%), but the detection rates of LA-A and LA-B were not significantly different between the two groups (P = 0.897 and P = 0.311, respectively). After comparison of the interobserver agreement using randomly selected video clips, the i-SCAN group showed better agreement than the WL group (Kappa value, 0.793 vs. 0.473). Compared to WL endoscopy, applying i-SCAN in daily practice can improve the diagnostic yield of reflux esophagitis by detecting more minimal changes in the squamo-columnar junction of the esophagus and can improve the interobserver agreement of the modified Los Angeles classification.

Serial examination of serum IL-8, IL-10 and IL-1Ra levels is significant in neonatal seizures induced by hypoxic-ischaemic encephalopathy.

We investigated changes in the levels of significant cytokines in relation to neonatal seizures, a pattern of cytokine concentrations serially and the severity of brain insult. The hypoxic-ischaemic encephalopathy-induced seizure group consisted of 13 patients, and another 15 normal newborns were enrolled as a control group. All of the initial samples were obtained within the first 24 h of admission, and the second samples were obtained between 48 and 72 h in both groups. Only the third samples were taken in the seizure group on the 5th day. During neonatal seizures, the levels of most cytokines increased within 24 h, and, in particular, the levels of interleukin (IL)-8 significantly increased (P < 0.05). After 48-72 h of seizure onset, the levels of most cytokines decreased, especially, IL-1Ra; however, IL-8 and IL-10 remained increased (P < 0.05). During the prognosis, one patient who was diagnosed with quadriplegic cerebral palsy at 6 months of age presented extreme elevation of IL-1beta, IL-1Ra, IL-6, IL-8, IL-10 and tumor necrosis factor-alpha in the initial sample, reflecting the severity of brain damage. A significant increase in IL-8 may serve as a biomarker for earlier detection of brain damage in neonatal seizure, if detected within 24 and 48-72 h of the seizure.

Comparison of transnasal small-caliber vs. peroral conventional esophagogastroduodenoscopy for evaluating varices in unsedated cirrhotic patients.

BACKGROUND AND STUDY AIMS: We aimed to evaluate the accuracy of transnasal small-caliber esophagogastroduodenoscopy (TNSC-EGD) compared with peroral conventional EGD (POC-EGD) for evaluating varices in unsedated patients with liver cirrhosis. The success rate, safety, endoscopist satisfaction, and patient tolerability of TNSC-EGD were also addressed. PATIENTS AND METHODS: One hundred patients with liver cirrhosis participated in this randomized crossover trial, and 84 subjects completed both procedures. Of the 84 patients, 28 had marked bleeding diathesis (platelet count ≤ 50000/mm (3) and/or prothrombin time ≥ 1.7 INR). Endoscopists and patients answered questionnaires using a 100-mm visual analog scale about, respectively, their satisfaction and their tolerance of the procedure. RESULTS: The success rate of TNSC-EGD was comparable to that of POC-EGD (96% vs. 99%). Nasal mucosal hemorrhages induced by TNSC-EGD occurred in 5 patients (6%), but were easily controlled. Compared to the POC-EGD reference test, diagnostic accuracies of TNSC-EGD for detecting esophageal varices, gastric varices, and red color signs were 98%, 98%, and 96%, respectively. Concordance rates on grading esophageal varices and gastric varices were excellent at 93% (κ = 0.85) and 96% (κ = 0.87). Endoscopist satisfaction was not significantly different between TNSC-EGD and POC-EGD, whereas patient tolerance of TNSC-EGD was significantly greater than that of POC-EGD (79.0 ± 14.4 vs. 69.5 ± 16.1; P = 0.001). CONCLUSION: TNSC-EGD without sedation was found to be feasible, safe, and accurate for evaluating esophageal varices, gastric varices, and red color signs in patients with cirrhosis - even in those with marked bleeding diathesis. Furthermore, it was significantly better tolerated by patients, without altering endoscopist satisfaction. Our findings indicate that TNSC-EGD without sedation might be viewed as a potential alternative to POC-EGD for evaluation of varices.

G protein beta3 subunit, interleukin-10, and tumor necrosis factor-alpha gene polymorphisms in Koreans with irritable bowel syndrome.

BACKGROUND: The association between irritable bowel syndrome (IBS) based on Rome III criteria and G protein beta3 subunit (GNB3), interleukin (IL)-10, and tumor necrosis factor (TNF)-alpha gene polymorphisms is uncertain. METHODS: Case and control subjects were recruited from Korean visitors to the Health Promotion Center and Digestive Disease Center for gastrointestinal endoscopy. G protein beta3 subunit, IL-10, and TNF-alpha gene polymorphisms were genotyped using a polymerase chain reaction-based method. Multifactor dimensionality reduction (MDR) analysis was used to assess gene-gene interactions. KEY RESULTS: Genotype and allele frequencies of GNB3 showed marginal significance between the healthy controls and IBS patients (chi(2) = 5.92, P = 0.052; chi(2) = 3.76, P = 0.053). G protein beta3 subunit T allele was more strongly correlated with IBS with constipation (12 of constipation-dominant type and 31 of mixed type) than with 51 diarrhea-dominant type and 88 normal subjects (chi(2) = 13.91, P = 0.008). Multifactor dimensionality reduction analysis revealed that there were no significant interactions of GNB3, IL-10, and TNF-alpha gene variants with susceptibility to IBS (P > 0.05). CONCLUSIONS & INFERENCES: The results suggest that GNB3 825T allele might be associated with IBS with constipation in Koreans.

Clinical features associated with improvement of fatty liver disease.

BACKGROUND: We presumed that identification of the factors associated with improvement of fatty livers disease (FLD) would support the therapeutic options for FLD. The goal of this study was to clarify what clinical characteristics are associated with biochemical and sonographic improvements in the non-alcoholic population with fatty livers. METHODS: A total of 615 non-alcoholic men had elevated alanine aminotransferase (ALT) (> or = 40 IU/L) levels and sonographic evidence of a fatty liver, and their clinical characteristics were assessed at the beginning of the study and after 1 year of follow up. The improvement was defined as combination of normal ALT level and negative sonography for hepatic fat after 1 year. Programmed intervention or medications were not applied in this study population. RESULTS: The overall rate of improvement of FLD after a 1-year follow up was 37/615 (6.0%). The improvement was strongly associated with decrement of changes in bodyweight, body mass index, waist circumference, gamma-glutamyltransferase, fasting blood sugar, total cholesterol, triglycerides, low-density lipoprotein cholesterol, total cholesterol/high-density lipoprotein cholesterol ratio and homeostasis model assessment. Multivariate analysis showed that decrement of changes in bodyweight (odds ratio (OR) = 1.56; 95% confidence interval (95%CI): 1.27-1.92) per 1 kg, body mass index (OR = 2.42; 95%CI: 1.58-3.71) per 1 SD (0.8 kg/m2), waist circumference (OR = 2.13; 95%CI: 1.02-4.54) per 1 cm, and low-density lipoprotein cholesterol (OR = 1.64; 95%CI: 1.05-2.56) per 1 SD (22 mg/dL) were all independent predictors for improvement of FLD. CONCLUSIONS: These results suggest that the reduction of bodyweight is a major key point for the improvement of FLD.

Role of autonomic dysfunction in patients with functional dyspepsia.

BACKGROUND: The role of autonomic dysfunction in patients with functional dyspepsia is not completely understood. AIMS: 1. to prospectively assess abnormalities of autonomic function in patients with functional dyspepsia, 2. to assess whether autonomic dysfunction in these patients is associated with a. visceral hypersensitivity or b. delayed gastric emptying or c. severity of dyspeptic symptoms. PATIENTS: A series of 28 patients with functional dyspepsia and 14 healthy volunteers without gastrointestinal symptoms were studied. METHODS: All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests, dyspeptic questionnaire, gastric barostat tests and gastric emptying tests. RESULTS: 1. Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than in controls; 2. visceral hypersensitivity was confirmed in dyspeptics in response to proximal gastric distension, demonstrating lower pain threshold; 3. delayed gastric emptying occurred more frequently in patients with functional dyspepsia than in controls; 4. epigastric pain and epigastric burning were significantly more prevalent in patients with definite evidence of autonomic dysfunction; 5. No significant association was found between presence of autonomic dysfunction and presence of visceral hypersensitivity or presence of delayed gastric emptying in patients with functional dyspepsia. CONCLUSIONS: We concluded that a possible role of autonomic dysfunction in eliciting dyspeptic symptoms could not be determined from alterations in visceral hypersensitivity or delayed gastric emptying. Autonomic dysfunction might not be the major explanation for symptoms associated with functional dyspepsia.

The effects of time and intensity of supplemental blue lighting during morning twilight on growth and physiological performance of cucumber seedlings.

Cucumbers (Cucumis sativus L. cv. Naoyosi) were grown hydroponically at air temperatures of 28/24 degrees C (D/N) and photosynthetic photon flux (PPF) of 300 micromoles m-2 s-1, in a walk-in type growth cabinet equipped with 3-band fluorescent lamps. Plants were subjected to supplemental blue lighting applied daily just before the 14-h photoperiod (morning twilight) under PPFs of 0, 10, 30, 100, and 200 micromoles m-2 s-1. Treatment periods were 0, 5, 30, or 120 min. Growth and morphological parameters were measured after 12 and 14 days of treatment. On the 13th day of treatment, the stomatal conductance (gs), transpiration rate (Tr), and net photosynthetic rate (Pn) were measured under 3-band fluorescent lamps at a PPF of 200 micromoles m-2 s-1. After 17-19 days of treatment, changes in Pn effected by supplemental blue light were measured continuously for 30 min. Treatment with 5 min of blue lighting promoted more growth than treatment for 30 or 120 min. Similarly, gs, Tr, and Pn were the greatest in plants grown with supplemental blue light of 30 micromoles m-2 s-1 and 100 micromoles m-2 s-1 PPF for 5 min. Pn in plants grown under blue light of 30 micromoles m-2 s-1 for 5 min increased by 60% compared with that of control plants. Pn rose and was maintained at a higher level with 5-min blue lighting treatment. Supplemental lighting with blue light in the morning twilight is considered to be effective for seedling growth, and can be utilized for bionursery facilities to increase efficiency of plant production.

Growth and neurodevelopmental outcome of very low birth weight infants with intrauterine growth retardation: comparison with control subjects matched by birth weight and gestational age.

Eighty-one very low birth weight (VLBW) infants were followed for 3 years to assess the relative impact of intrauterine growth retardation on growth and development; 27 small for gestational age (SGA) infants were compared with 27 gestation-matched infants with appropriate size for gestational age (AGA) and 27 birth weight-matched AGA infants. It was hypothesized that growth and neurodevelopmental outcomes in SGA VLBW infants are poorer than those of AGA gestation-matched (AGA-GA) infants but do not differ from those of birth weight-matched (AGA-BW) control infants. Gestational ages of the SGA, AGA-GA, and AGA-BW infants were 29 +/- 2, 29 +/- 1, 26 +/- 2 weeks, and birth weights were 821 +/- 178, 1124 +/- 85, and 848 +/- 141 gm, respectively. The SGA infants did not differ from the AGA infants in neonatal course, but AGA weight-matched infants had lower Apgar scores and more days of assisted ventilation, and an increased incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, and seizures. At 3 years of age the SGA VLBW infants had lower weight and height than both comparison groups (p < 0.05). Neurologic outcome in SGA infants did not differ from that in AGA-GA infants. The AGA-BW infants had an increased incidence of suspect or abnormal neurologic findings at 2 and 3 years of age (p < 0.05). The SGA infants scored lower on developmental tests at 1, 2, and 3 years than AGA-GA infants but had scores similar to those of the AGA-BW group. We conclude that intrauterine growth retardation in VLBW infants has a significant long-term impact on growth. Although 3-year development of SGA infants is significantly lower than that of gestation-matched control infants, it does not differ from that of weight-matched control infants.

Biliary proteins in patients with and without gallstones.

BACKGROUND: Nucleation from supersaturated bile of calcium salts of cholesterol and bilirubinate is essential in the formation of gallstone. Nucleation requires gallbladder mucin and its main component, glycoprotein, may contribute to gallstone formation by providing a nidus or matrix for precipitation of lipid components. However, biliary protein patterns of patients with gallstones have not been completely explored. METHODS: We have tried to extract, isolate and characterize the proteins in patients with gallstones and without gallstones. 21 bile samples were obtained from patients with different types of gallstones and with no stones at cholecystectomy. Biliary protein concentrations were measured by Lowry and Bensadoun methods, and individual glycoproteins from each of the patients were compared by silver staining and densimetric quantification of Sodium Dodesyl Sulfate Polyacrylamide Gel Electrophoresis. RESULTS: 1) Among 16 gallstones, 5 were cholesterol stones, 5 were calcium bilirubinate stones, and 6 were black pigment stones. 2) The mean protein concentration was highest in bile with cholesterol stones (47.6 mg/ml), 24.2 mg% in bile without gallstones, and 15.9 mg/ml in brown pigment stones. 3) Cholesterol gallstones were found to have 14.2 KD glycoproteins, whereas pigment stones were found to have 66 KD glycoproteins. CONCLUSIONS: Gallbladder proteins from both cholesterol and pigment stones play an important role in the nucleation and growth of calcium salt crystals.