Human assisted reproductive technology programs have been being developed marvelously during this decade. However, implantation rates following embryo replacement remain low, regardless of increased fertilization rates by ICSI. One proposed possibility limiting the successful implantation is an impaired hatching caused by suboptimal culture conditions. As to improve the hatching potential of blastocysts, assisted hatching by an artificial alteration of zona pellucida(ZP) have been done in many laboratories using the various methods. We tried to investigate whether the supplementation of proteases into culture media has any effect on development, zona structure, and/or hatching of mouse embryos. Supplementation of either pronase E(PE) or proteinase K(PK) in culture media did not affect development up to blastocyst but significantly increased hatching rate. And we observed the alteration of ultrastructure and casein binding properties of ZP in mouse embryos. Also we investigated the effects of protease on development of human embryos and pregnancy rates in human ART program. From July 1994 to December 1996, 792 cycles(for study I) and 1095 cycles(for study II) undergoing the IVF-ET program in MizMedi Hospital were randomly selected for BAH. The concentrations of proteases used in this study were 1microgram/ml PE, 0.1microgram/ml PK and 1microgram/mlPE+0.1microgram/ml PK in HTF with 0.5% human serum albumin(HSA), and in vitro fertilized embryos were cultured for 24 hours. We analyzed the efficiency and stability of biochemical assisted hatching(BAH) according to the clinical profiles of patients and fertilization methods. After cultured in HTF with proteases for 24 hours of human embryos, the thinning in zona pellucida of embryos was observed but its development was not disturbed. Also, clinical pregnancy rates were higher in the PE, PK and PE+PK groups than the control group without proteases(36.0%(32/89), 35.3%(36/102), 35.1%(39/111) vs. 25.5%(125/490), p<0.05). The live birth rate in the PE, PK and PE+PK groups were increased than control, and the abortion rate were not different. They were showed a effect and safety of proteases treatment in human embryos. We selected PE as BAH for study II because of slightly better embryonic morphology and pregnancy rate. In patients over 35 years old, clinical pregnancy rates of the BAH group was higher than that of the control group(31.4%(58/185) vs. 22.2%(51/230); p<0.05). And in the cases with few oocytes retrieval, or less than 3 cycles of IVF-ET, clinical pregnancy rates of the BAH group was significantly higher than that of the control group(36.8%(86/234) vs. 27.2%(93/342), p<0.05; 36.8%(148/402) vs. 29.9%(168/562), p<0.05). In BAH groups, the clinical pregnancy rate was similar between conventional IVF and ICSI group. From above results, it is suggested that improved hatching by protease treatment is due to physiological alteration of ZP structure, giving rise to the similar hatching process to that in vivo. We suggest that BAH using protease is a simple, safe and economic technique compared to the other known assisted hatching techniques in human ART program.
Abortion, Induced ; Adult ; Animals ; Blastocyst ; Caseins ; Culture Media ; Embryonic Structures* ; Female ; Fertilization ; Herpes Zoster ; Humans* ; Live Birth ; Mice ; Oocytes ; Peptide Hydrolases ; Pregnancy Rate ; Pronase ; Reproductive Techniques, Assisted ; Sperm Injections, Intracytoplasmic ; Zona Pellucida

From retrospective review of 111 tibial fractures treated by interlocking intramedullary nailing, 38 operative errors in 28 cases(25%) were included in this study. The errors were classified into two categories. The first category included eighteen errors that related to fracture reduction; nine angular malalignments, four failures in closed nailing to open the fracture site, two peroneal nerve palsies, two shortenings of tibial length(more than 1cm), and one rotational malalignment. The second category comprised twenty errors that related to the nailing itself; eight protrusions of proximal nail tip, five overdistractions of fracture gap (more than 3mm), four additional fragmentations, two mistakes in interlocking screw insertion, and one ankle joint injury by the distal nail tip. Functional results of those 28 cases at the last follow-up(average, 17.5 months; range, 9 to 29 months) were excellent or good in only 60.8 per cent, while the control group treated by adequate operative technique showed excellent or good results in 92.8 per cent.
Ankle Joint ; Fracture Fixation, Intramedullary ; Paralysis ; Peroneal Nerve ; Retrospective Studies ; Tibial Fractures

Damage-associated molecular patterns (DAMPs) are endogenous danger molecules that are released from damaged or dying cells and activate the innate immune system by interacting with pattern recognition receptors (PRRs). Although DAMPs contribute to the host's defense, they promote pathological inflammatory responses. Recent studies have suggested that various DAMPs, such as high-mobility group box 1 (HMGB1), S100 proteins, and heat shock proteins (HSPs), are increased and considered to have a pathogenic role in inflammatory diseases. Here, we review current research on the role of DAMPs in inflammatory diseases, including rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, atherosclerosis, Alzheimer's disease, Parkinson's disease, and cancer. We also discuss the possibility of DAMPs as biomarkers and therapeutic targets for these diseases.
Alzheimer Disease ; Arthritis, Rheumatoid ; Atherosclerosis ; Biomarkers ; Heat-Shock Proteins ; Immune System ; Inflammation ; Lupus Erythematosus, Systemic ; Osteoarthritis ; Parkinson Disease ; Receptors, Pattern Recognition ; S100 Proteins

Objective: : The fate of partially thrombosed intracranial aneurysms (PTIAs) is not well known after endovascular treatment. The authors aimed to analyze the treatment outcomes of PTIAs. Methods: : We retrospectively reviewed the medical records of 27 PTIAs treated with endovascular intervention between January 1999 and March 2018. Twenty-one aneurysms were treated with intraluminal embolization (ILE), and six were treated with parent artery occlusion (PAO) with or without bypass surgery. Radiological results, clinical outcomes and risk factors for major recurrence were assessed. Results: : The initial clinical status was similar in both groups; however, the last status was better in the ILE group than in the PAO group (p=0.049). Neurological deterioration resulted from mass effect in one case and rupture in one after ILE, and mass effect in two and perforator infarction in one after PAO. Twenty cases (94.2%) in the ILE group initially achieved complete occlusion or residual neck status. However, 13 cases (61.9%) showed major recurrence, the major causes of which included coil migration or compaction. Seven cases (33.3%) ultimately achieved residual sac status after repeat treatment. In the PAO group, all initially showed complete occlusion or a residual neck, and just one case ultimately had a residual sac. Two cases showed major recurrence, the cause of which was incomplete PAO. Aneurysm wall calcification was the only significantly protective factor against major recurrence (odds ratio, 36.12; 95% confidence interval, 1.85 to 705.18; p=0.018). Conclusion : Complete PAO of PTIAs is the best option if treatment-related complications can be minimized. Simple fluoroscopy is a useful imaging modality because of the recurrence pattern.

Objective: : The fate of partially thrombosed intracranial aneurysms (PTIAs) is not well known after endovascular treatment. The authors aimed to analyze the treatment outcomes of PTIAs. Methods: : We retrospectively reviewed the medical records of 27 PTIAs treated with endovascular intervention between January 1999 and March 2018. Twenty-one aneurysms were treated with intraluminal embolization (ILE), and six were treated with parent artery occlusion (PAO) with or without bypass surgery. Radiological results, clinical outcomes and risk factors for major recurrence were assessed. Results: : The initial clinical status was similar in both groups; however, the last status was better in the ILE group than in the PAO group (p=0.049). Neurological deterioration resulted from mass effect in one case and rupture in one after ILE, and mass effect in two and perforator infarction in one after PAO. Twenty cases (94.2%) in the ILE group initially achieved complete occlusion or residual neck status. However, 13 cases (61.9%) showed major recurrence, the major causes of which included coil migration or compaction. Seven cases (33.3%) ultimately achieved residual sac status after repeat treatment. In the PAO group, all initially showed complete occlusion or a residual neck, and just one case ultimately had a residual sac. Two cases showed major recurrence, the cause of which was incomplete PAO. Aneurysm wall calcification was the only significantly protective factor against major recurrence (odds ratio, 36.12; 95% confidence interval, 1.85 to 705.18; p=0.018). Conclusion : Complete PAO of PTIAs is the best option if treatment-related complications can be minimized. Simple fluoroscopy is a useful imaging modality because of the recurrence pattern.

PURPOSE: The aim of this study was to inquire about the clinical performance and determine the performance pattern of medical students in standardized patient (SP) based examinations of domestic violence (DV). METHODS: The clinical performance sores in DV station with SP of third-year (n=111, in 2014) and 4th-year (n=143, in 2016) medical students of five universities in the Busan-Gyeongnam Clinical Skills Examination Consortium were subjected in this study. The scenarios and checklists of DV cases were developed by the case development committee of the consortium. The students’ performance was compared with other stations encountered in SP. The items of the checklists were categorized to determine the performance pattern of students investigating DV into six domains: disclosure strategy (D), DV related history taking (H), checking the perpetrator’s psychosocial state (P), checking the victim’s condition (V), negotiating and persuading the interviewee (N), and providing information about DV (I). RESULTS: Medical students showed poorer performance in DV stations than in the other stations with SP in the same examination. Most students did confirm the perpetrator and commented on confidentiality but ignored the perpetrator’s state and patient’s physical and psychological condition. The students performed well in the domains of D, H, and I but performed poorly in domains P, V, and N. CONCLUSION: Medical students showed poor clinical performance in the DV station. They performed an ‘event oriented interview’ rather than ‘patient centered’ communication. An integrated educational program of DV should be set to improve students’ clinical performance.
Checklist ; Child ; Child Abuse ; Clinical Competence ; Confidentiality ; Disclosure ; Domestic Violence* ; Education, Medical, Undergraduate ; Humans ; Negotiating ; Students, Medical

Anhydrous ammonia is a commonly used chemical in industry. Ammonia gas inhalation causes thermal injuries and alkali burns in the airway and lung parenchyma. Previous case reports have stated that respiratory sequelae after acute ammonia inhalation burns were associated with structural lung disease, such as bronchiectasis or interstitial lung disease. We herein report two cases of long-term sequelae with persistent airflow limitation after ammonia inhalation burns.

Background: Intrapleural urokinase is one of the most widely used fibrinolytic agents in the treatment of complicated parapneumonic effusion (CPPE). However, little research has been performed on the optimal urokinase dosage. The aim of this study was to evaluate the treatment efficacy of half dose urokinase compared with conventional dose urokinase. Methods: We retrospectively enrolled 92 patients with CPPE or empyema who underwent intrapleural urokinase treatment at two tertiary hospitals. Patients received antibiotics, chest tube drainage, and other treatments as part of routine care. The primary outcome was the treatment success rate in the half dose urokinase group (50,000 IU daily for maximal 6 days) and the conventional dose urokinase group (100,000 IU daily). Treatment success was defined as clinical and radiological improvements without surgical treatment or re-admission within one month. Results: Forty-four patients received half dose urokinase, whereas 48 patients were treated with conventional dose urokinase. Both groups were relatively well matched at baseline, excluding higher serum white blood cell count and higher empyema prevalence in the half dose urokinase group. The treatment success rate was not different between the two groups (p=0.048). There were no differences in the rate of in-hospital death and surgical treatment, hospitalization duration, and indwelling catheter duration. In the multivariate analysis, urokinase dose was not a predictor of treatment success. Conclusion Half dose intrapleural urokinase is equally effective conventional dose urokinase in treating patients with CPPE or empyema.

Obstructive jaundice by vascular compression is rare. The causative arteries were identified as the right hepatic artery, gastroduodenal artery, cystic artery, proper hepatic artery, and an unspecified branch of the common hepatic artery. Also the venous system, such as enlarging collateral veins in cases of portal hypertension was a causative vessel. Herein, we describe a case of a proximal choledocholithiasis due to compression of the common bile duct by right hepatic artery originated from gastroduodenal artery. Final diagnosis and treatment were achieved through an operation.
Cholangiography ; Common Bile Duct/blood supply/*pathology/surgery ; Diagnosis, Differential ; *Hepatic Artery ; Humans ; Jaundice, Obstructive/*diagnosis/etiology/radiography ; Male ; Middle Aged ; Tomography, X-Ray Computed

PURPOSE: We sought to evaluate the feasibility and outcomes of laparoscopic resection of giant hepatic cysts and surgical success, focusing on cyst recurrence. METHODS: From February 2004 to August 2011, 37 consecutive patients with symptomatic hepatic cysts were evaluated and treated at Dong-A University Hospital. Indications were simple cysts (n = 20), multiple cysts (n = 6), polycystic disease (n = 2), and cystadenoma (n = 9). RESULTS: The median patient age was 64 years, with a mean lesion diameter of 11.4 cm. The coincidence between preoperative imaging and final pathologic diagnosis was 54% and half (n = 19) of the cysts were located in segments VII and VIII. Twenty-two patients had American Society of Anesthesiologists (ASA) classification I and II, and nine had ASA classification III. Surgical treatment of hepatic cysts were open liver resection (n = 3), laparoscopic deroofing (n = 24), laparoscopic cyst excision (n = 4), laparoscopic left lateral sectionectomy (n = 2), hand assisted laparoscopic procedure (n = 2), and single port laparoscopic deroofing (n = 2). The mean fellow-up was 21 months, and six patients (16%) experienced radiographic-apparent recurrence. Reoperation due to recurrence was performed in two patients. Among the factors predicting recurrence, multivariate analysis revealed that interventional radiological procedures and pathologic diagnosis were statistically significant. CONCLUSION: Laparoscopic resection of giant hepatic cysts is a simple and effective method to relieve symptoms with minimal surgical trauma. Moreover, the recurrence is dependent on the type of pathology involved, and the sclerotherapy undertaken.
Cystadenoma ; Hand ; Humans ; Laparoscopy ; Liver ; Multivariate Analysis ; Recurrence ; Reoperation ; Sclerotherapy