PURPOSE: Recent studies have indicated that cytokines and inflammatory responses are related to hemorrhagic shock-(HS) induced acute lung injury. Novel, synthetic, broad-acting serine protease inhibitors that protect a wide range of animals from lethal shock have been evaluated as potential immunoresuscitation modulators. The aim of this study was to test the hypothesis that a test modulator could decrease serum and tissue pro-inflammatory mediator levels, prevent HS-induced acute lung injury, and suppress activation of the inflammatory cascade. METHODS: This HS model consisted of four phases: Phase I, initiation of HS (from 15~30 min) with a volume-controlled hemorrhage of 2.7 mL/100 g over 15 min; Phase II, maintenance of HS (HS Phase, from 30~90 min), with maintenance of shock without resuscitation; Phase III, resuscitation (RT phase, from 90~150 min), with reinfusion of 1.5 mL/100 g of blood and Ringer's lactate fluid; and Phase IV, observation and post-resuscitation (OB phase, from 150~270 min). The test rats were randomized into two groups of 15: group 1 with fluid resuscitation (control group) and group 2 with fluid and 0.5mg/kg nafamostat mesilateinfusion (treated group). RESULTS: The mean arterial pressure (MAP) of the treated group increased significantly during the observation and post-resuscitation period (Phase IV, OB 90 min). The heart rate of the control group increased significantly during the maintenance of shock (Phase II, HS 60 min), resuscitation (Phase III, RT 30 and 60 min), and observation periods (Phase IV, OB 120 min). The serum concentrations for IL-6 and IL-10 did not differ significantly between the treated and control groups. The TNF-alpha levels for the treated group were significantly lower than those of the control group (p<0.05). At the end of the observation period (OB 120 min), the treated group had significantly lower concentrations of IL-8 in the bronchoalveolar lavage fluid (BALF) than the control group (676.7+/-791.9 vs. 1062.5+/-609.9, p=0.013). CONCLUSION: We conclude that the tested serine protease inhibitor improves hemodynamic parameters, prevents acute lung injury after HS, and attenuates a robust proinflammatory cytokine response in rats.
Acute Lung Injury ; Animals ; Arterial Pressure ; Bronchoalveolar Lavage Fluid ; Cytokines ; Guanidines ; Heart Rate ; Hemodynamics ; Hemorrhage ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Isotonic Solutions ; Lactic Acid ; Lung ; Rats ; Resuscitation ; Serine Proteases ; Serine Proteinase Inhibitors ; Shock ; Shock, Hemorrhagic ; Tumor Necrosis Factor-alpha

BACKGROUND: Complete resection by the surgery has been selected as the treatment of choice in lung cancer patients, but in cases of recurrence after excision or inoperable cases, the importance of anticancer chemotherapy has been emphasized. If one can select a set of the sensitive chemotherapeutic agents before anticancer chemotherapy, it will give more favourable results. Subrenal capsular assay has been recognized as a useful in-vivo chemosensitivity test of thoracic and abdominal tumors and it can be done in a short time for a rapid interpretation of tumor responsiveness to anticancer chemotherapeutic drugs. It has been reported that various kinds of cancer cells can be implantable to the kidney, but so far there is no comparative study of xenogeneic cell implantation on liver, spleen and kidney. The author implanted the human lung cancer cells under the capsule of S.D rat's liver, spleen and kidney respectively and compared the pattern of growth and histology. MATERIAL AND METHOD: After incubation of human lung cancer cell line (SW-900 G IV) in RPMI 1640 (Leibovitz L-15 medium) culture media, 3x3x3 mm size fibrin clots which contain 108 cancer cells were made. Thereafter the fibrin clots were implanted at subcapsule area of liver, spleen and kidney of S.D. female rat. For immune suppression, cyclosporin-A (80 mg/Kg) was injected subcutaneously daily from post-implantation first day to sixth day. The body weight was measured at pre and post implantation periods. The growth pattern and the size of tumor mass were observed and the pathologic examination and serum tumor marker tests were performed. RESULT: Body weight increased in both of control and experimental groups. Serum Cyfra 21-1 was not detected. Serum levels of CEA and NSE revealed no significant change. The SCC-Ag increased significantly in implanted group. The growth rate of human lung cancer cells which was implanted on spleen was higher than on liver or kidney. The surface area, thickness, and volume of tumor mass were predominant at spleen. The success rates of implantation were 80% on kidney, 76.7% on spleen and 43.3% on liver. Pathologic examination of implanted tumors showed characteristic findings according to different organs. Tumors that were implanted on kidney grew in a round shape, small and regular pattern. In the spleen, tumors grew well and microscopic neovascularization and tumor thrombi were also found, but the growth pattern was irregular representing frequent daughter mass. Human lung cancer cells that were implanted in the liver, invaded to the liver parenchyme, and had low success rate of implantation. Microscopically, coagulation necrosis and myxoid fibrous lesion were observed. CONCLUSION: The success rate of implantation was highest in the kidney. And the mass revealed regular growth that could be measured easily. The SCC-Ag was presented earlier than CEA or Cyfra21-1. The Cyfra21-1 was not detected at early time after implantation. The best model for tumor implantation experiment for chemosensitivity test was subrenal capsular analysis than liver and spleen and the useful serum tumor marker in early period of implantation was the SCC-Ag.
Animals ; Body Weight ; Cell Line ; Cell Transplantation ; Culture Media ; Drug Therapy ; Female ; Fibrin ; Heterografts* ; Humans* ; Kidney* ; Liver* ; Lung Neoplasms* ; Lung* ; Models, Animal ; Necrosis ; Nuclear Family ; Rats ; Recurrence ; Spleen*

PURPOSE: The purpose of present study was to retrospectively analyze the survival rate of narrow diameter implant less than 3.6 mm by initial stability and radiographic measurements. MATERIALS AND METHODS: In total, 24 patients who received 38 narrow diameter implants (≤ 3.6 mm in diameter, ≥ 7 mm in length) were enrolled in this retrospective study. The cumulative survival rate was calculated and various factors were investigated according to the implant platform diameter, body diameter, length, position, concomitant use of guided bone regeneration in implant placement and final prosthesis type. Initial stability was investigated with implant stability quotient (ISQ) value. The mesial and distal marginal bone level (MBL) change was calculated with radiography. RESULTS: The overall survival rate was 92.11%. Mean ISQ value and MBL change of survival implants was 66.26 and 0.14 ± 0.31 mm, respectively. None of the implants with platform diameters larger than the body diameter failed. CONCLUSION: In conclusion, the findings of present study suggest that narrow diameter implant could be predictable treatment in narrow alveolar ridge.
Alveolar Process ; Bone Regeneration ; Humans ; Prospective Studies ; Prostheses and Implants ; Radiography ; Retrospective Studies ; Survival Rate

BACKGROUND: The endoscopic vein harvesting (EVH) method has been used in coronary artery bypass surgery in many countries. We started using the EVH method recently, and investigated the results during the early learning period. METHODS: Between March 2012 and June 2014, 75 patients (31 patients in the EVH method group, and 44 patients in the open method group) who underwent isolated first-time coronary artery bypass grafting using vein grafts were retrospectively analyzed with respect to the early outcomes including graft patency and risk factors for leg wound complications. For assessing the patency of vein graft, we performed coronary computed tomography angiography during the immediate postoperative period and 6 months later. RESULTS: Mean harvesting time of endoscopic method was about 15 minutes. Patency rate during the immediate operative period and the 6-month patency rate were similar between the two groups (postoperative period: EVH 100% vs. open method 94.4%, p=0.493; at 6 months: EVH 93.3% vs. open method 90.9%, p=0.791). Leg wound complications occurred more frequently in the open method group (EVH 3.2% vs. open method 13.6%, p=0.127). According to the analysis, age was an independent risk factor for leg wound complications. CONCLUSION: EVH is a feasible method even for beginners and can be performed satisfactorily during their learning period.
Angiography ; Coronary Artery Bypass ; Endoscopy ; Humans ; Learning* ; Leg ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Tissue and Organ Harvesting ; Transplants ; Veins* ; Wounds and Injuries

BACKGROUND: There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. METHODS: The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, 18.3+/-10.3 months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. RESULTS: There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. CONCLUSION: HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Mammary Arteries ; Medical Records ; Mortality ; Myocardial Revascularization ; Percutaneous Coronary Intervention ; Retrospective Studies ; Skin ; Sternotomy* ; Surgical Procedures, Minimally Invasive ; Wounds and Injuries

Hepatosplenic candidiasis is also called chronic disseminated candidiasis and usually seen in patients with hematologic malignancies who have just recovered from an episode of neutropenia. Gastric candidiasis most commonly present as a mucosal lesion such as an ulcer or erosions, but other gastric lesion is very rare. We experienced a case of gastric candidiasis which presented as gastric subepithelial mass in a 60-year old woman who had undergone the 2nd consolidation chemotherapy due to acute myeloid leukemia. The pathologic diagnosis was confirmed by fine needle aspiration of the gastric subepithelial mass under the guidance of endoscopic ultrasonography.
Candidiasis/*diagnosis/immunology ; Endoscopy, Gastrointestinal ; Female ; Humans ; *Immunocompromised Host ; Middle Aged ; Stomach Diseases/microbiology/*pathology/ultrasonography ; Tomography, X-Ray Computed

BACKGROUND: The aging of skin is influenced by genetic, environmental, and hormonal factors. Estrogens are the "missing" player in the skin of postmenopausal women. In postmenopausal women, loss of collagen was related to decreased estrogen level. Phytoestrogens, i.e. isoflavone, are plant compounds with estrogen-like biologic activities. OBJECTIVE: The effects of 18beta-estradiol, and isoflavones on production of type I collagen in the fibroblast of postmenopausal woman, keloid and Detroit cell line were examined. METHODS: Type I collagen was measured with procollagen type I C-peptide EIA KIT. RESULTS: 18beta-estradiol and isoflavone enhanced the production of type I collagen in cultured fibroblast of postmenopausal woman and keloid. But isoflavone inhibited the production of collagen in cultured fibroblast of Detroit cell. CONCLUSION: 18beta-estradiol and isoflavone can prevent and improve the cutaneous alterations caused by loss of collagen of postmenopausal women.
Aging ; C-Peptide ; Cell Line ; Collagen Type I ; Collagen* ; Estradiol ; Estrogens* ; Female ; Fibroblasts ; Humans ; Isoflavones* ; Keloid ; Phytoestrogens ; Plants ; Skin

Aluminum nanoparticles (Al-NPs) are one of the most widely used nanomaterial in cosmetics and medical materials. For this reason, Al-NP exposure is very likely to occur via inhalation in the environment and the workplace. Nevertheless, little is known about the mechanism of Al-NP neurotoxicity via inhalation exposure. In this study, we investigated the effect AL-NPs on the brain. Rats were exposed to Al-NPs by nasal instillation at 1 mg/kg body weight (low exposure group), 20 mg/kg body weight (moderate exposure group), and 40 mg/kg body weight (high exposure group), for a total of 3 times, with a 24-hr interval after each exposure. Inductively coupled plasma mass spectrometry (ICP-MS) analysis indicated that the presence of aluminum was increased in a dose-dependent manner in the olfactory bulb (OFB) and the brain. In microarray analysis, the regulation of mitogen-activated protein kinases (MAPK) activity (GO: 0043405), including Ptprc, P2rx7, Map2k4, Trib3, Trib1, and Fgd4 was significantly over-expressed in the treated mice than in the controls (p = 0.0027). Moreover, Al-NPs induced the activation of ERK1 and p38 MAPK protein expression in the brain, but did not alter the protein expression of JNK, when compared to the control. These data demonstrate that the nasal exposure of Al-NPs can permeate the brain via the olfactory bulb and modulate the gene and protein expression of MAPK and its activity.
Aluminum* ; Animals ; Body Weight ; Brain* ; Inhalation ; Inhalation Exposure ; Mass Spectrometry ; Mice ; Microarray Analysis ; Mitogen-Activated Protein Kinases ; Nanoparticles* ; Nanostructures ; Olfactory Bulb ; p38 Mitogen-Activated Protein Kinases ; Plasma ; Rats*

OBJECTIVE: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. METHODS: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. RESULTS: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4–9 vs. 6; IQR, 4–8; P < 0.001). Mechanical ventilator (29% vs. 21%, P < 0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78–1.28; P=0.999) for the transferred group compared with the non-transferred group. CONCLUSION: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Logistic Models ; Mortality ; Observational Study* ; Odds Ratio ; Prognosis ; Prospective Studies ; Renal Replacement Therapy ; Retrospective Studies* ; Sepsis ; Shock ; Shock, Septic* ; Tertiary Care Centers* ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the status of LDL-cholesterol level and its relationship with subsequent cardiovascular events in Korean patients with chronic stable angina. METHODS: The patients with stable angina were retrospectively and consecutively enrolled from out-patients clinic during 2007-2009. Mean follow-up duration was 3 years. Occurrences of major adverse cardio-cerebrovascular event (MACCE: a composite of death, myocardial infarction, unstable angina, coronary revascularization, cerebrovascular events, peripheral artery disease and aortic disease requiring hospital admission.) were compared by initial LDL-cholesterol levels using Cox proportional-hazards model. RESULTS: 1,683 subjects were enrolled from 9 hospitals. Initial median LDL-cholesterol by tertile was 62.2, 90.2, and 124.0mg/dL respectively, however, the differences in LDL-cholesterol level among initial 3 tertile groups became narrow at 3rd year (67.8, 85.0, and 91.6mg/dL, respectively). MACCE occurred in 138 (8.2%) subjects, including 127 coronary events, 9 cerebrovascular events and 2 peripheral artery disease during the 3-year follow-up. The adjusted hazard ratio for MACCE was 1.02 (95% confidence interval 0.64-1.64) in the middle tertile of LDL-cholesterol, 1.53 (p=0.063, 95% Confidence Interval 0.98-2.40) in the highest tertile of LDL-cholesterol. The newly diagnosed diabetes mellitus was more frequent in subjects with statin treatment than subjects without statin during the 3-year follow-up (1.5% vs 0.6%). CONCLUSION: Increased cardiovascular risk was observed in angina patients with higher initial LDL-cholesterol levels during the 3-year follow-up, although the differences were statistically insignificant.
Angina, Stable* ; Angina, Unstable ; Aortic Diseases ; Cardiovascular Diseases* ; Diabetes Mellitus ; Dyslipidemias* ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Korea ; Myocardial Infarction ; Outpatients ; Peripheral Arterial Disease ; Retrospective Studies ; Secondary Prevention*