Many patients with Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome(TTP-HUS) satisfactorily respond to plasma exchange. Some patients, however, respond either not at all or only transiently and incompletely. In the refractory case, endothelial cell-derived unusually large von Willebrand factor multimers(ULvWFM) have an important role in the formation of microthrombi. As the ULvWFM may be removed in the cryoprecipitate, we reason the plasma depleted of cryoprecipitate(the plasma cryosupernatant) should be considered for effectiveness in the treatment of refractory TTP- HUS. We experienced a 48 year old woman presented with diarrhea, jaundice and oliguria. She had microangiopathic hemolytic anemia, renal impairment, platelets of 21,000/mm3 and LDH 3,258U/L. She had not improved after plasma exchange with fresh frozen plasma(FFP)(1.5 plasma volumeX7 days). On hospital day 8, her HUS had not responded, platelets of 37,000/mm3 and LDH 1,588U/L. Substitution of cryosupernatant for FFP was associated with prompt increased in the platelet count to normal and complete resolution of HUS. Therefore. the cryosupernatant fraction of plasma should be considered as an alternative to whole FFP for plasma exchange if there is continuing platelet consumption and microvascular thrombosis in spite of intensive conventional plasma therapy.
Anemia, Hemolytic ; Blood Platelets ; Diarrhea ; Female ; Hemolytic-Uremic Syndrome* ; Humans ; Jaundice ; Middle Aged ; Oliguria ; Plasma Exchange* ; Plasma* ; Platelet Count ; Thrombosis ; von Willebrand Factor

Two percent of neurological complications after spine surgery for various reasons have been reported. Most are static or improve with time. We encountered two cases of newly developed, progressive neurological deficits with severe pain radiating along the exiting root after posterior decompression, adhesiolysis, posterior lumbar interbody fusion (PLIF) with a cage for spinal stenosis after previous lumbar spine surgery. When explored, the severely tightened and less movable, edematous exiting root was entrapped by a pedicle without evidence of pedicle violation, direct injury, epidural hematoma or iatrogenic foraminal stenosis. A wider decompression with a resection of the pedicle reduced the root course and made it more movable. Immediately, the severe radiating pain subsided and the neurological deficit recovered. A progressive neurological deficit after spinal surgery for spinal diseases with foraminal stenosis can develop as a result of the inordinate manipulation of the root, which may provoke root edema, root self-entrapment around a pedicle and local ischemia. An image test and exploration should be performed immediately in cases of progressive single root neurological deficits immediately after spine surgery. Total decompression, even with a pedicle resection, should be considered to resolve the neurological deficits.
Constriction, Pathologic ; Decompression* ; Edema ; Hematoma ; Ischemia ; Neurologic Manifestations* ; Spinal Diseases ; Spinal Stenosis ; Spine*

BACKGOUND: Interferon-alpha2b has already proven to be effective in the clinical treatment of virus-originated diseases such as hairy cell leukemia, condyloma acuminatum, and AIDS-related Kaposi's sarcoma. The use of recombinant interferon-alpha2b may allow various types of wart to be treated relatively atraumatically and with less incidence of recurrence. OBJECTIVE: We tried to compare the effectiveness and safety of intralesional injections of recombinant interferon-alpha2b with natural interferon-alpha2b in the treatment of patients with various types of wart. METHOD: Patients with more than two warts were treated by injecting the different warts with 0.5 to 1.0X105 IU/1mm3 of recombinant and natural interferon-alpha2b, twice per week for 4 to 20 weeks. The response to treatment was followed up at 36 weeks. RESULTS: At the end of treatment, clearing of the treated warts had occurred in 83.3% of the recombinant interferon-alpha2b group and 91.6% of the natural interferon-alpha2b group. A more rapid cure rate was observed in the natural interferon-alpha2b group than in the recombinant interferon-alpha2b group. The rest showed partial improvement. With evaluation for relapse up to 16 weeks after treatment, warts were found to relapse in 11.1% of both the recombinant and natural interferon groups. CONCLUSION: Intralesional natural interferon-alpha2b has a better therapeutic effect than recombinant interferon-alpha2b, and may be considered as a therapeutic modality of recalcitrant verruca or when it can be anticipated that destructive techniques or blistering agents will not be tolerated.
Blister ; Humans ; Incidence ; Injections, Intralesional ; Interferons ; Leukemia, Hairy Cell ; Recurrence ; Sarcoma, Kaposi ; Warts*

Liver tissuses obtained from 5 human fetuses between 11 weeks and 23 weeks of gestation during the high activity of hepatic hemopoiesis were observed with transmission electron microscope using continuous series of thin sections. The objective of present study was to evaluate ultrastructures of megakaryopoietic cells, the migration of extravascular megakaryocyte into the sinusoidal lumen and the relevence between a migrated megakaryocyte and a Kupffer cell. Immature megakaryocytes were usually observed between growing hepatic laminae and within hepatic sinusoids. A megakaryoblast contained numerous polyribosomes, rather large mitochondria, short tubular elements of rough endoplasmic reticulum and small granules. Moreover, demarcation tubules and a few small specific granules were observed in immature megakaryocytes. The nucleus was mononuclear but frequently indented. With maturation, the nuclei were multilobulated. In the cytoplasm, in contrast to the decrease in polyribosomes and rough endoplasmic reticulum, the numerous specific granules and well -developed demarcation membrane system were predominant. Thereafter cytoplasmic zonation was observed clearly in maturing and mature megakaryocytes. Some megakaryocytes passed through the sinusoidal lining epithelium and into the hepatic sinusoids. The cell to cell interaction was often found as adhesion between migrated megakaryocyte and Kupffer cell, and erythroblasts within megakaryocyte (emperipolesis). These results suggest that intravascular megakaryopoiesis in addition to extravascular megakaryopoiesis occurs to produce platelet during the human fetal liver.
Blood Platelets ; Cell Communication ; Cytoplasm ; Emperipolesis ; Endoplasmic Reticulum, Rough ; Epithelium ; Erythroblasts ; Fetus* ; Humans* ; Liver ; Megakaryocyte Progenitor Cells ; Megakaryocytes* ; Membranes ; Mitochondria ; Polyribosomes ; Pregnancy ; Thrombopoiesis

BACKGROUND/OBJECTIVES: One of the mechanisms considered to be prevalent in the development of Alzheimer's disease (AD) is hyper-stimulation of microglia. Black chokeberry (Aronia melanocapa L.) is widely used to treat diabetes and atherosclerosis, and is known to exert anti-oxidant and anti-inflammatory effects; however, its neuroprotective effects have not been elucidated thus far. MATERIALS/METHODS: We undertook to assess the anti-inflammatory effect of the ethanolic extract of black chokeberry friut (BCE) in BV2 cells, and evaluate its neuroprotective effect in the lipopolysaccharide (LPS)-induced mouse model of AD. RESULTS: Following stimulation of BV2 cells by LPS, exposure to BCE significantly reduced the generation of nitric oxide as well as mRNA levels of numerous inflammatory factors such as inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2), interleukin 1 beta (IL-1β), and tumor necrosis factor alpha (TNF-α). In addition, AD was induced in a mouse model by intraperitoneal injection of LPS (250 µg/kg), subsequent to which we investigated the neuroprotective effects of BCE (50 mg/kg) on brain damage. We observed that BCE significantly reduced tissue damage in the hippocampus by downregulating iNOS, COX-2, and TNF-α levels. We further identified the quinic acids in BCE using liquid chromatography-mass spectrometry (LCMS). Furthermore, we confirmed the neuroprotective effect of BCE and quinic acid on amyloid beta-induced cell death in rat hippocampal primary neurons. CONCLUSIONS: Our findings suggest that black chokeberry has protective effects against the development of AD.
Alzheimer Disease ; Amyloid ; Animals ; Atherosclerosis ; Brain ; Cell Death ; Cyclooxygenase 2 ; Ethanol ; Hippocampus ; Inflammation ; Injections, Intraperitoneal ; Interleukin-1beta ; Mice ; Mice, Inbred ICR ; Microglia ; Neurons ; Neuroprotective Agents ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Phytochemicals ; Quinic Acid ; Rats ; RNA, Messenger ; Spectrum Analysis ; Tumor Necrosis Factor-alpha

PURPOSE: To evaluate whether Extracorporeal Shock Wave Therapy (ESWT) is an effective treatment without side effects for chronically painful calcifying tendinitis. MATERIALS AND METHODS: Study subjects were 72 patients (17 males and 55 females) aged 37-64 years, with a mean of 48, showing chronic, symptomatic, calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Calcifications were type I or type II according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients with type 3 calcific tendinitis were excluded, because this type has a strong tendency to spontaneous resolution. Extracorporeal shock wave therapy comprised one or two treatments, each consisting of 800 shocks, with a frequency of 120 impulse per minute and the energy density of 0.14 mJ/mm2. We assessed the presence and size of calcified deposits at 1, 3, 6 and 12 months by conventional radiography. All patients also underwent clinical examination, and the Constant (and Murley) score and pain were calculated. The intensity of pain was measured with the visual analogue scale (VAS) from 0 to 10 points, where 0 represents the absence of pain and 10 unbearable pain. RESULTS: One month after the treatment, complete resorption of the calcium deposits was observed in 19 patients (26%), partial resorption was observed in 26 patients (36%), and no modification in the calcium deposits was observed in 27 patients (38%). At six months the complete disappearance of the calcium deposits was noted in 42 patients (68%), but in the 10 patients (14%), calcium deposit appeared unchanged. This result is remained unvaried after 6 month follow-up. Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function (p<0.001). At six months, 76% of the patients presented satisfactory functional result. About 15% reported a subjective and objective recovery, and only 6 patients (8%), classified as poor result but in our series no differences were found between results at 6 month and 12 month follow-up. At 12 month follow-up there were differences in the Constant score between treated shoulder and contralateral side, respectively 77.6 (59-91) and 87.2 (74-96), but not significant. There were no side effects. CONCLUSION: ESWT is an effective treatment without side effects and an alternative therapy for chronically painful calcifying tendinitis of the shoulder refractory to conventional therapies.
Calcium ; Classification ; Follow-Up Studies ; Humans ; Male ; Radiography ; Shock* ; Shoulder* ; Tendinopathy*

BACKGROUND: Studies on the relationship between vitamin D and visceral fat area (VFA; intra-abdominal fat area) have been actively conducted. But, there is a few Korean population-based studies about the association between serum vitamin D level and VFA. The aim of our study was to explore the correlation between serum 25-hydroxyvitamin D (25[OH]D) levels and VFA measured using bioelectrical impedance analysis (BIA; electric impedance) in healthy Korean adults. METHODS: This cross-sectional study involved 1,945 adults aged 20-70 years who visited a health promotion center. All subjects underwent the BIA to estimate the VFA. Serum 25(OH)D level was measured using chemiluminescent immunoassay. Multiple regression analysis was performed to identify independent correlation of VFA and serum 25(OH)D level. RESULTS: The prevalence of vitamin D deficiency (25[OH]D: 20-29 ng/mL) and insufficiency (25[OH]D <20 ng/mL) were 54.4% and 38.1%, respectively. After having adjusted age and season, VFA were negatively associated with serum 25(OH)D levels in both men (P<0.001) and women (P<0.001). The obese group with VFA ≥ 100 cm² had significant lower serum 25(OH)D level in men (P<0.001) and women (P=0.0034). CONCLUSIONS: VFA measured using BIA could be negatively associated with serum 25(OH)D levels in healthy Korean adult.
Adult* ; Cross-Sectional Studies ; Electric Impedance ; Female ; Health Promotion ; Humans ; Immunoassay ; Intra-Abdominal Fat* ; Male ; Obesity ; Prevalence ; Seasons ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) serves as an extracellular signal triggering apoptosis in tumor cells. To characterize the molecular events involved in TRAIL-induced apoptotic signaling, we investigated the role of extracellular signal-regulated kinase 1/2(ERK1/2) in the apoptosis using HeLa cells. Here we show that TRAIL pronounced ERK1/2 activation through a tyrosine kinase-dependent mechanism, subsequently elevated anti-apoptotic Bcl-2 protein levels. Pretreatment with Genistein, an inhibitor of tyrosine kinase, significantly attenuated ERK1/2 activation and enhanced cell death. Moreover, inhibition of ERK1/2 with PD98059 promoted apoptotic cell death through the down-regulation of ERK1/2 activity and Bcl-2 protein levels. Taken together, our results suggest that the activation of ERK1/2 via tyrosine kinase pathway plays a protective role as the mechanism of cellular defense through the up-regulation of Bcl-2 protein levels in TRAIL-induced apoptosis.
Apoptosis* ; Cell Death ; Down-Regulation ; Genistein ; HeLa Cells* ; Humans ; Necrosis ; Phosphotransferases ; Protein-Tyrosine Kinases* ; Tyrosine* ; Up-Regulation

Various factors such as senescence, stress, neurodegenerative diseases including Alzheimer's disease (AD) contribute to the impairments of organs, especially brain. Also, they should be negative factors on normal brain function, like as memory and cognition. In this study, the neuroprotective role of BF-7, extracted from Bombyx mori, was examined agaist scopolamine-induced neurotoxicity in SK-N-SH cells. In order to know if the BF-7 has positive role on the cognition and memory, we examined using SD rat model and human. Scopolamine-induced memory impairments were observed, as measured by the passive avoidance and water maze tests, but treatment with BF-7 significantly improved memory and cognitive function. Moreover, the memory index and memory preservation of clinical experiments using MMSE-K tests were significantly improved memory and cognitive function. This results strongly represent that the BF-7 play effectively positive role in the improvement of brain function including learning and memory. Taken together, our results suggested that the BF-7 should be useful for developing strategies protecting nervous system and improving brain function.
Aging ; Alzheimer Disease ; Bombyx ; Brain ; Cognition ; Humans ; Learning ; Memory* ; Models, Animal ; Nervous System ; Neurodegenerative Diseases ; Scopolamine Hydrobromide