T cell activation is a critical event for initiation and regulation of immune responses and inhibitors of such signaling pathways are clinically useful for the treatment of patients received allogratt and autoimmune disease. In the course of screening soil microorganisms from the forest of Cheju island in Korea for new immunosuppressive agent, one of Streptomyces species (CK-95441) was found to produce a new immunosuppressant, tautomycetin which also had antifungal activity. Tautomycetin showed the inhibition of T cell proliferation in murine mixed lymphocyte reaction (MLR) and T cell activation induced by concanavalin A. Tautomycetin also blocked the induction of IL-2 gene expression which was examined in Jurkat TAg cell line in which multiple NFAT-binding sites and minimal IL-2 promoter drive the production of B-galactosidase. Also, the level of inhibition in activation-induced IL-2 receptor expression by tautomycetin was greater than those by cyclosporin A measured by flow cytometry. But, Fas ligand-induced apoptosis in Jurkat cells was unaffected by tautomycetin which was measured by DNA fragmentation assay. These results suggested that tautomycetin will be able to be used as a potent immunosuppressive drug following organ transplantation.

PURPOSE: Laparoscopic common bile duct exploration (LCBDE) has more advantages than conventional common bile duct surgery, but the use of this route for stone removal and biliary drainage remains controversial. The goal of this study was to investigate the usefulness of LCBDE in patients who had been failed in the endoscopic stone extraction. METHODS: From November 2005 to August 2008, 52 patients underwent LCBDE due to failure of endoscopic stone extraction in Chungnam National University Hospital. Clinical data were collected and analyzed retrospectively. RESULTS: Duodenal diverticulum (23 cases, 44.2%) was the most common cause in failure of endoscopic stone extraction and large common bile duct stone 12 cases (23.1%), previous upper gastrointestinal operation 10 cases (19.2%) were followed. Twenty four patients did not have preoperative biliary drainage, such as PTBD, ENBD, PTGBD. Forty-five patients (86.5%) of the 52 participating patients underwent LCBDE successfully, but 7 cases resulted in open surgery for the following reasons: 3 cases of severe intraabdominal adhesions, 3 cases of stone impaction in ampulla portion, and 1 case of a remnant stone. External biliary drainage was performed in 41 cases with T-tube (31 cases, 68.9%), PTBD (7 cases, 15.6%), ENBD (3 cases, 6.7%). The stone clearance of LCBDE was 95.6%. Remnant stone weredetected in 2 cases (4.4%) and removed with choledochoscope via external biliary drain. Postoperative complications happened in 5 cases (9.5%). Procedure related complications happened in 2 cases (3.8%). CONCLUSION: LCBDE is useful technique in patients with failed endoscopic stone extraction, and biliary drainage may be necessary for detection and removal of latent remnant CBD stones.
Common Bile Duct ; Dioxolanes ; Diverticulum ; Drainage ; Fluorocarbons ; Humans ; Postoperative Complications

In 38 of 70 patients who underwent lumbar spinal surgery, we performed a randomized, prospective double-blind study of the effect of caudal block with morphine sulfate on postoperative pain levels. Age, sex, clinical features, postoperative analgesic consumption, pain score, adverse effects and patient satisfaction on discharge were recorded. The consumption of parenteral analgesics on the 1st, 2nd and 3rd days was significantly lower in the morphine sulfate group(p<0.05), than in the control group. Caudal block with morphine sulfate also led to marked reductions in pain levels and thus increases patients satisfaction during the postoperative period(p<0.05). Transient respiratory depression occurred in three of 38 patients(7.9%), but further treatment was not needed. Seventeen patients(44.7%) developed urinary retention, but this recovered spontaneously. The present study demonstrates that caudal block with morphine sulfate leads to a highly significant reduction in pain during postoperative periods and a corresponding reduction in the need for additional postoperative analgesics, in addition, patients are more satisfied.
Analgesics ; Double-Blind Method ; Humans ; Morphine* ; Pain, Postoperative* ; Patient Satisfaction ; Postoperative Period ; Prospective Studies ; Respiratory Insufficiency ; Urinary Retention

The systematic study of products from bacteria and fungi has led to the development of two immunosuppressive drugs, cyclosporin A and FK 506 (tacrolimus) which are useful to suppress adaptive immune responses to the grafted tissue. However, they affect all immune responses indiscriminately and are both toxic to kidneys and other organs. To facilitate the development of immunosuppressor to block the T cell receptor (TcR)-mediated signaling cascade specifically, a novel Jurkat T cell transfectants, JK NFAT-SEAP were generated in which the expression of the secreted alkaline phosphatase (SEAP) is driven by the multiple NFAT binding sites plus minimal IL-2 promoter. Upon stimulation with ionomycin or anti-TcR mAb OKT3 in the presence of PMA, these transfectants secreted high level of SEAP into the medium, which was conveniently analyzed by SEAP analysis. The secretion of SEAP was effectively inhibited by cyclosporin A or FK 506 at the concentration of [10 ' ug/ml], [10 ug/ml] respectively. JK NFAT-SEAP transfectants will provide two major advantages for the development of a novel immunosuppressor. First, analysis of SEAP secreted into the culture medium by SEAP analysis enables us to test a large number of samples within a short period of time. Second, Usage of IL-2 promoter for the expression of SEAP makes us identify bioproducts to target specifically on TcR-mediated signaling pathway.
Alkaline Phosphatase ; Bacteria ; Binding Sites ; Cell Line* ; Cyclosporine ; Fungi ; Interleukin-2 ; Ionomycin ; Kidney ; Mass Screening* ; Muromonab-CD3 ; Receptors, Antigen, T-Cell ; T-Lymphocytes* ; Tacrolimus ; Transplants

No abstract available.
Hemangioma* ; Polyhydramnios*

OBJECTIVE: Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. METHODS: Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. RESULTS: POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 min), and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. CONCLUSION: Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.
Alcoholism ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Local ; Blood Glucose ; Delirium ; Dementia ; Glucose ; Humans ; Incidence ; Length of Stay ; Long-Term Care ; Pain, Postoperative ; Postoperative Period ; Potassium ; Recovery Room ; Retrospective Studies ; Risk Factors ; Sodium

PURPOSE: The purpose of this study was to determine the prevalence of distress and to investigate the related problems in breast cancer patients at the end of primary treatment. METHODS: A sample of 118 participants was recruited among outpatients who had successfully completed primary treatment of breast cancer. Data were collected between July, 2013 and October, 2014 using the Distress Thermometer (DT) scale and problem lists. Descriptive statistics and logistic regression analysis were used to analyze data. RESULTS: Among the 118 patients that participated in this study, 34 patients (28.8%) suffered from elevated distress using the previously validated cut point > or =4 for the DT. Problems most frequently encountered were fatigue (68.8%), worry (59.3%), appearance (51.7%) and memory/concentration (48.3%). Multivariate logistic regression analysis revealed that depression (OR=9.55), worry (OR=8.34), fatigue (OR=8.19) and age (OR=1.14) were independent predictors for elevated distress scores. CONCLUSION: Utilizing the DT, onethird of breast cancer patients screened met criteria for distress at the end of the primary treatment. Breast cancer patients with depression, worry, fatigue and older age should be targeted for distress screening and management.
Breast Neoplasms* ; Breast* ; Depression ; Fatigue ; Humans ; Logistic Models ; Mass Screening ; Outpatients ; Prevalence ; Survivors ; Thermometers

OBJECTIVE: The authors report a result of application of cervical hollow cage(RABEA(TM)) without bone graft to the patients of one-level cervical spondylosis or acute cervical disc herniation to fill and stabilize a vacant space following anterior decompression. METHODS: Twenty-one patients from May 1999 to April 2001 had been taken procedure with cervical hollow cage system following anterior decompression and there had been no additional bone graft or screw fixation or fusion. Pain relief and clinical outcome were evaluated, and the intervertebral disc height and segmental angle for radiological assessment were examined. All patient were followed up for 12 months at least. RESULTS: The result was excellent in 14 cases(66.7%), good in 6 cases(28.6%) and poor in 1 case(4.8%). In the lateral projection, the mean of preoperative disc height and segmental angle were significantly improved after surgery and maintained during follow-up periods. No abnormal displacement were recorded at dynamic flexion and extension lateral X-ray and no cage rotation or retropulsion was noted in follow-up periods. Three patients(14.3%) was observed to subside of disc height on the postoperative periods and only one of their patients was dissatisfied with surgery. CONCLUSION: Cervical hollow cage is simple to perform and reduces the operation time. Besides clinical improvement, it improves mechanical stability and radiological profile as the physiologic level. The cervical hollow cage might be an alternative to traditional cervical interbody fusion with bone graft.
Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Postoperative Period ; Spondylosis ; Transplants*

PURPOSE: Psychological distress is a significant and ongoing problem for breast cancer. These mental health problems are often neglected as they are not always properly understood. This study was performed to explore the trajectory of psychological distress over 1 year since breast cancer surgery and to identify the associated factors for the trajectory. METHODS: One hundred seventeen women who underwent surgery for breast cancer completed the psychological distress thermometer and problem lists from after surgery to 12 months after surgery. Information on their sociodemographic and clinical characteristics was also obtained. Group-based trajectory modeling was performed to identify the distinct trajectories of psychological distress. Chisquare test and logistic regression analysis were performed to determine predictors of psychological distress trajectories. RESULTS: two-group linear trajectory model was optimal for modeling psychological distress (Bayesian information criterion = −777.41). Group-based trajectory modeling identified consistently high-distress (19.4%) and low-decreasing distress (80.6%) trajectories. Old age, depression, nervousness, and pain were significant predictors of consistently high-distress trajectory. CONCLUSION: Our results indicate that distinct trajectory groups can be used as a screening tool to identify patients who may be at an increased risk of psychological distress over time. Screening for psychological distress during disease diagnosis is important and necessary to identify patients who are at an increased risk of elevated distress or at risk of experiencing psychological distress over time.
Anxiety ; Breast Neoplasms* ; Breast* ; Depression ; Diagnosis* ; Female ; Humans ; Logistic Models ; Mass Screening ; Mental Health ; Stress, Psychological ; Thermometers

PURPOSE: The purpose of this study was to examine the effects of integrated psychoeducational program for distress management of newly diagnosed patients with breast cancer. METHODS: A quasi-experimental trial was conducted. The participants consisted of 47 female patients with breast cancer assigned to an intervention group (n=25) and control group (n=22). The intervention group participated in integrated psychoeducational program, consisting of individual face-to-face education and telephone-delivered health-coaching sessions. Data were collected at three time points: pre-intervention (T1), post-intervention (T2), and 6-month follow-up (T3). Study instruments were Distress thermometer, Supportive Care Needs Survey Short Form 34 and Functional Assessment of Cancer Therapy-Breast. RESULTS: Compared with the control group, breast cancer patients in the intervention group reported lower distress and supportive care needs than the control group. The intervention group reported higher quality of life (QOL) overall and higher emotional well-being than the control group. CONCLUSION: These findings indicate that the integrated psychoeducational program is an effective intervention for reducing distress and supportive care needs and increasing QOL of newly diagnosed patients with breast cancer. Oncology nurses need to provide psychoeducational intervention to support patients with breast cancer in managing their distress and helping them adjust to their life.
Breast Neoplasms* ; Breast* ; Education ; Female ; Follow-Up Studies ; Humans ; Quality of Life ; Self Care ; Social Support ; Stress, Psychological ; Thermometers