Hyponatremia, the most common electrolyte disorder, has been rarely reported as causing rhabdomyolysis. Osmotic demyelination syndrome (ODS), a demyelinating disease of the central pons and/or other areas of the brain, is infrequently reported as associated with rapid correction of hyponatremia. This paper reports a case of ODS after correction of severe hyponatremia complicated by rhabdomyolysis. A 47-year-old female with a history of chronic alcoholism presented herself at the hospital with altered consciousness after three days of nausea and vomiting. She was on a thiazide diuretic for essential hypertension. Her blood tests upon her hospital admission showed hyponatremia (Na+ 98 mEq/L), hypokalemia (K+ 3.0 mEq/L), and elevation of her serum creatine phosphokinase (3,370 IU/L) with an increase in her serum myoglobin level 11,267 ng/mL). She was treated with intravenous fluid therapy that included isotonic and hypertonic salines along with potassium chloride. She became more alert, and her neurological condition gradually improved after the first five days of her therapy. On the ninth day after her admission, she developed progressive quadiaresis associated with dysarthria, dysphagia, and dystonia despite the resolution of her hyponatremia. Magnetic resonance imaging of her brain on 16th day revealed symmetrical areas of signal hyperintensity in her central pons, basal ganglia, and precentral gyrus in T2-weighted images, which are consistent with ODS. Her neurological symptoms steadily improved after six weeks with only supportive treatment and rehabilitation.
Alcoholism ; Basal Ganglia ; Brain ; Consciousness ; Creatine Kinase ; Deglutition Disorders ; Demyelinating Diseases ; Dysarthria ; Dystonia ; Female ; Fluid Therapy ; Hematologic Tests ; Humans ; Hypertension ; Hypokalemia ; Hyponatremia ; Magnetic Resonance Imaging ; Myoglobin ; Nausea ; Pons ; Potassium Chloride ; Rhabdomyolysis ; Vomiting

Urothelial cancer is the seventh most common cancer among men worldwide. Bacille de Calmette-Guérin is a type of anticancer immunotherapy that has been used to treat targeted bladder cancer, but the number of patients with treatment-refractory advanced urothelial cancer, patients has been increasing recently. To overcome this, enfortumab vedotin (novel nectin-4 targeting antibody-drug conjugate) known as antibody-drug conjugate (ADC), was approved. We describe the clinical development process of ADC and the potential for future development as a bladder cancer treatment.

Purpose: This study aimed to compare the intraoperative and postoperative outcomes between robotic and laparoscopic transperitoneal adrenalectomies. Methods: In this retrospective study, 93 patients underwent adrenalectomy using 2 surgical modalities: 45 patients underwent adrenalectomy using the da Vinci Xi system (robotic group), and 48 patients using laparoscopic devices (laparoscopic group). We compared the operation time, intraoperative bleeding, and hospital stay according to the surgical modality and tumor characteristics. Results: There were no significant differences in the operative time (P = 0.827), hospital stay (P = 0.177), and intraoperative bleeding (P = 0.174) between the groups. However, the robotic group showed a lower coefficient of variation in total operative time than that of the laparoscopic group (100.6 ± 23.3 minutes vs. 101.9±32.7 minutes, 0.230 vs. 0.321). When divided into 2 subgroups based on the tumor size (<3 cm and ≥3 cm), the robotic group with a tumor sized >3 cm had a shorter operative time than that of the laparoscopic group (P = 0.032). The robotic group also had fewer cases of intraoperative bleeding (P = 0.034). Conclusions Compared to the laparoscopic transperitoneal adrenalectomy, the robotic one achieved a lower deviation in total operative time and showed less bleeding and a shorter operative time, especially for tumors sized >3 cm.

Objective: To determine whether a fully immersive virtual reality (VR) intervention combined with conventional rehabilitation (CR) can improve upper limb function more than CR alone in patients with spinal cord injury (SCI), we conducted a prospective, randomized, controlled clinical trial. Methods: Participants were randomly assigned to either the control group (CG; n=10) or experimental group (EG; n=10). The participants in the CG received 60 minutes of conventional therapy per day, 4 days per week for 4 weeks, whereas those in the EG received 30 minutes of VR training and 30 minutes of conventional therapy per day, 4 days per week for 4 weeks. The clinical outcome measures included Medical Research Council grade, the American Spinal Injury Association upper extremity motor score (ASIA-UEMS), and scores in the Hand Strength Test, Box and Block Test, Nine-Hole Peg Test, Action Research Arm Test, and Korean version of the Spinal Cord Independence Measure (K-SCIM). The assessments were performed at the beginning (T0) and end of the intervention (T1). Results: Grip power and K-SCIM score significantly improved in the EG after the intervention. When comparing differences between the groups, elbow extensor, wrist extensor, ASIA-UEMS, grip power, lateral pinch power, and palmar pinch power were all significantly improved. Conclusion VR training of upper limb function after SCI can provide an acceptable adjunctive rehabilitation method without significant adverse effects.

Although intravesical instillation of Mycobacterium bovis bacillus Calmette-Guérin (BCG) is the most successful cancer immunotherapy for superficial bladder cancer, the serious side effects are frequently arisen by using live mycobacteria. To allow less toxic and more potent immunotherapeutic agents following intravesical BCG treatment for superficial bladder cancer, noninfectious immunotherapeutic drug instead of live BCG would be highly desirable. Recently, immune-enhancing adjuvants are considered an effective vaccine immunotherapy for cancer, providing enhanced antitumor effects and boosted immunity. The BCG-cell wall skeleton (BCG-CWS), the main immune active center of BCG, is a potent candidate as a noninfectious immunotherapeutic drug instead of live BCG against bladder cancer. However, the most limited application for anticancer therapy, it is difficult to formulate a water-soluble BCG-CWS due to the aggregation of BCG-CWS in both aqueous and nonaqueous solvents. To overcome the insolubility and improve the internalization of BCG-CWS into bladder cancer cells, it should be developed the lipid nanoparticulation of BCG-CWS, resulting in improved dispensability, stability, and small size. In addition, powerful technology of delivery systems should be applied to enhance the internalization of BCG-CWS, such as encapsulated into lipid nanoparticles using novel packaging methods. Here, we describe the progress in research on effects of BCG-CWS for cancer immunotherapy, development of lipid-based solvent, and packaging method using nanoparticles with drug delivery system.
Administration, Intravesical ; Bacillus ; Cell Wall Skeleton ; Drug Delivery Systems ; Immunotherapy ; Methods ; Mycobacterium bovis ; Nanoparticles ; Product Packaging ; Skeleton ; Solvents ; Urinary Bladder Neoplasms ; Urinary Bladder

BACKGROUND: Jehovah's Witnesses are well known for their refusal of blood transfusions which, challenges the safety of performing cardiac surgeries. Their stand regarding blood transfusions has garnered criticism from some medical and legal sources, but has also added incentive for the development of many bloodless surgery techniques. To assess the impact on the continuing progress of blood saving protocols and increasing operative risk; herein our results in this specific population are reported. METHODS: The medical records of Jehovah's Witnesses, who underwent cardiac surgeries without blood transfusions, between Feb 1996 and Sep 2005, were retrospectively reviewed. RESULTS: 103 surgical procedures were performed on 102 patients. The age of patients varied from 2 months to 78 years, with a sex ratio of 60:42 (Male:Female). Cardiopulmonary bypass (CPB) was used in 81 cases. The mean hemoglobin (Hb) and hematocrit (Hct) levels were 13.2 g/dl (8.1-17.3), and 39.2% (24.3-52.5) before surgery, and 11.8 g/dl (8.0-16.5), and 35.3% (24-49) after surgery, respectively. Recombinant human erythropoietin (rHuEPO) and iron were used in 95 and 69 cases before and after surgery, respectively. High dose aprotinin (2 million KIU IV loading dose, 2 million KIU into the pump prime volume and 500,000 KIU per hour of surgery as a continuous intravenous infusion) was used in 67 cases. Acute normovolemic hemodilutions were performed in 7 cases. Cell saver was used in all procedures. Re-operations were needed in two cases due to wound infections and one patient died-of arrhythmias on the 2nd post-operative day. CONCLUSIONS: Bloodless cardiac surgery can be performed on Jehovah's Witnesses, but effective care of such patients requires close collaborative team efforts and advance planning to ensure favorable outcomes. At our hospital, preoperative iron and rHuEPO, as well as high dose aprotinin and cell saver are routinely used where indicated.
Aprotinin ; Arrhythmias, Cardiac ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Cardiopulmonary Bypass ; Disulfiram ; Erythropoietin ; Hematocrit ; Hemodilution ; Humans ; Iron ; Jehovah's Witnesses ; Medical Records ; Motivation ; Retrospective Studies ; Sex Ratio ; Thoracic Surgery ; Wound Infection

Herpes zoster (HZ) has been reported in immunocompetent children who received the varicella vaccine. In vaccinated children, HZ can be caused by vaccine-strain or by wild-type varicella-zoster virus (VZV). Like wild-type VZV, varicella vaccine virus can establish latency and reactivate as HZ. We report two cases of HZ in otherwise healthy 16- and 14-month-old boys who received varicella vaccine at 12 months of age. They presented with a vesicular rash on their upper extremities three to four months after varicella vaccination. In one case, a swab was obtained by abrading skin vesicles and VZV was detected in skin specimens by polymerase chain reaction. The VZV open-reading frame 62 was sequenced and single nucleotide polymorphism analysis confirmed that the virus from skin specimen was vaccinestrain. This is the first HZ case following varicella vaccination confirmed to be caused by vaccine-strain VZV in the immunocompetent children in Korea. Pediatricians should be aware of the potential for varicella vaccine virus reactivation in vaccinated young children.

Bariatric or metabolic surgery is a safe and effective intervention for patients with obesity at higherrisk. In 2019, after the reimbursement in Korea, the number of metabolic surgery cases has rapidly increased. We aimed to introduce the current metabolic surgery concepts.Current Concepts: Patients with a body mass index (BMI) of ≥35 kg/m2 without coexisting medical problems and those with a BMI of ≥30 kg/m2 and ≥1 severe obesity-related complication remediable by weight loss could be considered as the candidates for metabolic surgery. The standardized and effective procedures are adjustable gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The decision on bariatric procedures should be based on the characteristics of patients considering the effectiveness and anticipated complications.Discussion and Conclusion: Metabolic surgery was shown to induce greater weight loss, better control of comorbidities, such as type 2 diabetes, hypertension, and dyslipidemia, and more significant decrease in death compared to that of the nonsurgical approach. Postoperatively, a comprehensive approach consisting of psychosocial, behavioral, nutritional, and pharmacological aspects should be performed to amplify and maintain the effectiveness of metabolic surgery.

This study was performed to optimize scan delays for canine kidney by using a bolus-tracking technique. In six beagle dogs, computed tomography (CT) of the kidney was performed three times in each dog with different scan delays after a bolus-tracking trigger of 100 Hounsfield units (HU) of aortic enhancement. Delays were 5, 20, 35, and 50 sec for the first scan, 10, 25, 40, and 55 sec for the second scan, and 15, 30, 45, and 60 sec for the third scan. The renal artery-to-vein contrast difference peaked at 5 sec, and the renal cortex-to-medulla contrast difference peaked at 10 sec. The renal cortex-to-medulla contrast difference approached zero at a scan delay of 30 sec after the bolus trigger. For the injection protocol used in this study, the optimal scan delay times for renal arterial, corticomedullary, and nephrographic phases were 5, 10, and 30 sec after triggering at 100 HU of aortic enhancement using the bolus-tracking technique. The bolus-tracking technique is useful in multi-phase renal CT study as it compensates for different transit times to the kidney among different animals, requires a small dose of contrast media, and does not require additional patient radiation exposure.
Animals ; Contrast Media ; Dogs ; Humans ; Kidney ; Radiation Exposure

Purpose: We investigated the role of CD8+ T cells as host immune factors in pediatric patients with Helicobacter pylori gastritis. Methods: Gastric mucosal tissue and blood samples were collected from 39 children, including 11 children with H. pylori infection and 28 children as controls. Anti-CD8 and anti-T-bet antibodies were used for immunohistochemistry of the gastric mucosa. For the cell surface and intracellular staining, peripheral blood mononuclear cells were stained with anti-IL7Rα, anti-CX3CR1, anti-CD8, anti-T-bet, and anti-IFN-γ antibodies. Cytokines of sera such as tumor necrosis factor alpha (TNF-α) and CX3CL1 were analyzed using enzyme- linked immunosorbent assay (ELISA). Results: In the immunohistochemistry of gastric mucosa, the frequency of CD8+ and T-bet+ T cells cells was higher in the H. pylori-positive group than in the control group (26.9± 7.8% vs. 16.9±3.3%, p<0.001; 5.0±2.5% vs. 2.2±0.7%, p=0.001). Between the control and H. pylori-positive groups, the frequency of IL-7RαlowCX3CR1+ CD8+ and T-bet+ INF-γ+ CD8+ T cells were not significantly different between surface and intracellular staining, respectively (40.4±24.0% vs. 38.2±17.8%, p=0.914; 40.4±24.0% vs. 38.2±17.8%, p=0.914). In the ELISA, no significant differences in TNF-α and CX3CL1 concentrations were observed between the control and H. pylori-positive groups (34.3±12.1 pg/mL vs. 47.0±22.6 pg/mL, p=0.114/0.5± 0.1 pg/mL vs. 0.5±0.1 pg/mL, p=0.188). Conclusion CD8+ T and Th1 cells, which secrete IFN-γ, might play important roles in the mucosal immunity of the stomach in children with H. pylori infection.