Pneumocystis carinii causes serious pulmonary infection in immunosuppressed patients. This study was undertaken to observe the cytoskeletal proteins of P. carinii by immuno-electron microscopy. P. carinii infection was experimentally induced by immunosuppression of Sprague-Dawley rats for seven weeks, and their lungs were used for the observations of this study. The gold particles localized actin, tropomyosin, and tubulin. The actin was irregularly scattered in the cytoplasm of the trophic forms but was much more concentrated in the inner space of the cell wall of the cystic forms called the inner electron-lucent layer. No significant amount of tropomyosin was observed in either trophic forms or cystic forms. The tubulin was distributed along the peripheral cytoplasm and filopodia of both the trophic and cystic forms rather than in the inner side of the cytoplasm. Particularly, in the cystic forms, the amount of tubulin was increased and located mainly in the inner electron-lucent layer of the cell wall where the actin was concentrated as well. The results of this study showed that the cell wall of P. carinii cystic forms is a structure whose inner side is rich in actin and tubulin. The location of the actin and tubulin in P. carinii suggests that the main role of these proteins is an involvement in the protection of cystic forms from the outside environment by maintaining rigidity of the cystic forms.
Actins/analysis ; Animals ; Cytoskeletal Proteins/*analysis ; Fungal Proteins/*analysis ; Histocytochemistry ; Microscopy, Immunoelectron ; Pneumocystis/*chemistry/cytology ; Rats ; Rats, Wistar ; Support, Non-U.S. Gov't ; Tropomyosin/analysis ; Tubulin/analysis

Adherence of Candida albicans(C. albicans) to the surface of a denture is believed to be an initial and essential step in the formation of denture-induced stomatitis. Previous studies have provided enormous infomation on the relationship between composition of palatine gland/parotid saliva and upper denture stomatitis. Relatively little information is available on the correlation between lower denture stomatitis and sublingual-submandibular(SLSM) saliva. The plaque samples were collected from the two sites(100mm2) on the inner surface of lower partial denture corresponding to the stomatitis and healthy region of the lower partial dentures of 12 denture stomatitis patients and 6 normal persons who wore lower partial dentures. The samples were plated to isolate C. albicans on a selective Saboraud's dextrose agar plate and the isolates were identified by germ tube test and gram staining. The subjects were divided into group I (stomatitis with C. albican), group II (lesion without C. albicans), group III (no lesion but C. albicans), and group IV (normal and healthy denture wearer). Individual SLSM saliva (20microgram of protein) was analyzed by SDS-PAGE(SDS-poly-acrylamide gel electrophoresis) with Coomassie brilliant blue and PAS(Periodic Acid Schiff) staining. The salivary proteins separated in the polyacryamide gels were subjected to immunoblot analysis using anti-lactoferrin, anti-sIgA, and anti-secretory component of sIgA. In this study using custom made acrylic denture resin beads(5mm in diameter) coated with stimulated individual SLSM saliva, the binding ability of individual C. albicans strains to the beads was observed. Levels of C. albicans adhered to the acrylic resin beads were determined by measuring the optical density of the bound C. albicans to the beads at 580nm. The results showed that a higher number of C. albicans was observed in the lesion site than health site. The saliva of group I contained more high molecular weight glycoprotein(mucin, MG1) as compared to group II, III, and IV. And lactoferrin and sIgA affected to the binding ability of C. albicans to acylic resin beads. Binding ability of individual C. albicans to the acrylic resin coated with respective individual saliva was found to be greater in group I than the other 3 groups. And when bound cells of C. albicans isolated from individual subject #2 to the saliva coated beads were used, binding ability of subject #2 saliva coated beads was founed to be greater than the other subjects. These results suggested that denture induced stomatitis is related to individual patient's salivary protein composition, especially MG-1. Future studies will be directed toward saliva examination of patients who have general disease and analysis of pellicles formed on prosthesis with respect to oral disease.
Agar ; Candida albicans* ; Candida* ; Denture, Partial ; Dentures* ; Gels ; Glucose ; Glycoproteins* ; Humans ; Immunoglobulin A, Secretory ; Lactoferrin ; Molecular Weight ; Prostheses and Implants ; Saliva ; Salivary Proteins and Peptides ; Stomatitis ; Stomatitis, Denture*

PURPOSE: Percutaneous pin fixation is commonly applied for pediatric diaphyseal forearm fractures. We analyzed the results of percutaneous transphyseal intramedullary K-wires fixation for pediatric forearm fractures and evaluated the safety of this procedure in terms of growth. MATERIALS AND METHODS: Thirty-six pediatric patients with forearm diaphyseal fractures treated with transphyseal intramedullary K-wire fixation were reviewed retrospectively. Authors analyzed size and number of fixed K-wires and evaluated postoperative complications, bone length discrepancy and any deformity at the last follow-up. We also evaluated range of motion of wrist and forearm as a functional result. RESULTS: The mean age was 9.5 years old and the average period of follow-up was 53 months (range: 23-85 months). Single wire was applied in each bone, and 1.6 mm sized K-wire was most commonly used for radius fractures and 1.1 mm K-wire for ulnar fractures. There was one superficial pin site infection which was healed by conservative treatment. There were no other complications such as premature epiphyseal closure, discrepancy of forearm length or any deformity. All patients showed no significant difference in range of motion compared to opposite side at the last follow-up. CONCLUSION: Percutaneous transphyseal intramedulaary K-wire fixation is one of the effective and safe operative treatment for pediatric forearm fractures without any deleterious effects on subsequent growth of radius and ulna.
Congenital Abnormalities ; Follow-Up Studies ; Forearm ; Humans ; Postoperative Complications ; Radius ; Radius Fractures ; Range of Motion, Articular ; Retrospective Studies ; Ulna ; Wrist

PURPOSE: Percutaneous pin fixation is commonly applied for pediatric diaphyseal forearm fractures. We analyzed the results of percutaneous transphyseal intramedullary K-wires fixation for pediatric forearm fractures and evaluated the safety of this procedure in terms of growth. MATERIALS AND METHODS: Thirty-six pediatric patients with forearm diaphyseal fractures treated with transphyseal intramedullary K-wire fixation were reviewed retrospectively. Authors analyzed size and number of fixed K-wires and evaluated postoperative complications, bone length discrepancy and any deformity at the last follow-up. We also evaluated range of motion of wrist and forearm as a functional result. RESULTS: The mean age was 9.5 years old and the average period of follow-up was 53 months (range: 23-85 months). Single wire was applied in each bone, and 1.6 mm sized K-wire was most commonly used for radius fractures and 1.1 mm K-wire for ulnar fractures. There was one superficial pin site infection which was healed by conservative treatment. There were no other complications such as premature epiphyseal closure, discrepancy of forearm length or any deformity. All patients showed no significant difference in range of motion compared to opposite side at the last follow-up. CONCLUSION: Percutaneous transphyseal intramedulaary K-wire fixation is one of the effective and safe operative treatment for pediatric forearm fractures without any deleterious effects on subsequent growth of radius and ulna.
Congenital Abnormalities ; Follow-Up Studies ; Forearm ; Humans ; Postoperative Complications ; Radius ; Radius Fractures ; Range of Motion, Articular ; Retrospective Studies ; Ulna ; Wrist

BACKGROUND: Recently many studies reported that the postoperative pain was prevented or decreased from preoperative regional anesthesia by preventing the establishment of central sensitization(pre-emptive analgesia). Therefore, we evaluated the efficacy of preincisional lidocaine infiltration on the postoperative pain. METHODS: We conducted a study to compare preinfiltrating group with 1% lidocaine (30 ml), postinfiltrating group with 1% lidocaine (30 ml) and non-infiltrating group in 45 patients scheduled for elective inguinal herniorrhaphy. During operation, all patients received a general anesthesia with thiopental, isoflurane and nitrous oxide in oxygen. Postoperatively, pain scores on visual analogue scale (VAS) and on verbal rating scale(VRS) at rest, coughing and movement from supine into sitting position were assessed. Also the time to first request for an on-demand postoperative analgesics and the total dose of postoperative analgesics were assessed. And the number of patients who didn't require any analgesics during postoperative period was assessed. RESULTS: The VAS and VRS at rest, coughing, movement were low in preinfiltrating group than in non-infiltrating group and postinfiltrating group postoperatively, but it was statistically significant only in early postoperative period. The time to first request for an on-demand postoperative analgesics occurred later in preinfiltrating group than in non-infiltrating group and in postinfiltrating group and the total dose of supplemental analgesics (ketorolac) was smaller in the preinfiltrating group than in non-infiltrating group and postinfiltrating group, and the patients without analgesic treatment was less in the preinfiltrating group than in non-infiltrating group and postinfiltrating group, but it was not statistically significant. CONCLUSIONS: In patients with inguinal herniorrhaphy, we can not support the pre-emptive analgesia clinically with preincisional lidocaine infiltration.
Analgesia ; Analgesics ; Anesthesia, Conduction ; Anesthesia, General ; Anesthetics ; Cough ; Herniorrhaphy* ; Humans ; Isoflurane ; Lidocaine* ; Nitrous Oxide ; Oxygen ; Pain, Postoperative* ; Postoperative Period ; Thiopental

PURPOSE: This study evaluated the benefits of adjuvant chemotherapy on elderly patients with advanced gastric cancer (AGC) using meta-analysis of well-designed randomized controlled clinical studies. MATERIALS AND METHODS: PubMed, Embase, and Cochrane were searched to retrieve clinical studies evaluating the benefits of adjuvant chemotherapy in the elderly with AGC. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a fixed-effects model. RESULTS: Two studies were included in this meta-analysis to estimate HR for the overall survival (OS), and relapse-free survival (RFS) between adjuvant chemotherapy and surgery in elderly and non-elderly patients. HR for OS in the elderly and non-elderly was 0.745 (95% CI, 0.552 to 1.006, p=0.055) and 0.636 (95% CI, 0.522 to 0.776; p < 0.001), respectively, which showed no heterogeneity regarding HR between the two groups (p(interaction)=0.389). HR for RFS in the elderly and non-elderly was 0.613 (95% CI, 0.466 to 0.806; p < 0.001) and 0.633 (95% CI, 0.533 to 0.753; p < 0.001), respectively (p(interaction)=0.846). CONCLUSION: Meta-analysis suggests that the benefit of adjuvant chemotherapy to the elderly is not big enough to reach statistical significance while the HR for OS is less than 1 (0.745) and no heterogeneity are observed regarding the HR between the elderly and non-elderly patients.
Aged* ; Chemotherapy, Adjuvant* ; Humans ; Population Characteristics ; Stomach Neoplasms*

PURPOSE: The mechanical insights of death of cancer cells by ionizing radiation are not yet clearly defined. Recent evidences have demonstrated that radiation therapy may induce cell death via activation of signaling pathway for apoptosis in target cells. This study is designed whether ionizing radiation may activate the signaling cascades of apoptosis including caspase family cysteine proteases, Bcl2/Bax, cytochrome c and Fas/Fas-L in target cells. MATERIALS AND METHODS: HL-60 cells were irradiated in vitro with 6 MV X-ray at dose ranges from 2 Gy to 32 Gy. The cell viability was tested by MTT assay and the extent of apoptosis was determined using agarose gel electrophoresis. The activities of caspase proteases were measured by proteolytic cleavages of substrates. Western blot analysis was used to monitor PARP, Caspase-3, Cytochrome-c, Bcl-2, Bax, Fas and Fas-L. RESULTS: Ionizing radiation decreases the viability of HL-60 cells in a time and dose dependent manner. Ionizing radiation-induced death in HL-60 cells is an apoptotic death which is revealed as characteristic ladder-pattern fragmentation of genomic DNA over 16 Gy at 4 hours. Ionizing radiation induces the activation of caspase-2, 3, 6, 8 and 9 of HL-60 cells in a time-dependent manner. The activation of caspase-3 protease is also evidenced by the digestion of poly (ADP-ribose) polymerase and procaspase- 3 with 16Gy ionizing irradiation. Anti-apoptotic Bcl2 expression is decreased but apoptotic Bax expression is increased with mitochondrial cytochrome c release in a time- dependent manner. In additon, expression of Fas and Fas-L is also increased in a time dependent manner. CONCLUSION: These data suggest that ionizing radiation-induced apoptosis is mediated by the activation of various signaling pathways including caspase family cysteine proteases, Bcl2/Bax, Fas and Fas-L in a time and dose dependent manner.
Apoptosis ; Blotting, Western ; Caspase 2 ; Caspase 3 ; Cell Death ; Cell Survival ; Cysteine Proteases ; Cytochromes c ; Digestion ; DNA ; Electrophoresis, Agar Gel ; HL-60 Cells* ; Humans ; Peptide Hydrolases ; Radiation, Ionizing

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) observer variability to detect ectopic insertion of the pectoralis minor tendon (EIPMT) and to investigate changes in the rotator interval in patients with EIPMT using MRI. MATERIALS AND METHODS: A total of 507 shoulder MRIs (male:female = 259:248; mean age, 55.4 years) were classified into 1) normal type insertion of the pectoralis minor tendon, 2) complete type EIPMT, and 3) partial type EIPMT independently by two radiologists. Inter-observer agreement was calculated using the kappa coefficient. Thickness of the fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess was measured. MRIs were reviewed by consensus with regard to the grade of fibrotic scar tissue proliferation in the rotator interval. Comparisons were made between normal and EIPMT and between partial and complete type EIPMT. RESULTS: The incidence of EIPMT was 13.4% (complete type, 7.7%; partial type, 5.7%). Inter-observer agreement was substantial (kappa = 0.775). Fibrotic scar tissue in the subcoracoid triangle was thicker, and the grade of fibrotic scar tissue proliferation in the rotator interval was higher in the EIPMT group than those in the control group. No significant difference was observed in the thickness of humeral side axillary recess. The thicknesses of fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess as well as the grade of fibrotic scar tissue in the rotator interval were not significantly different between complete and partial type EIPMT. CONCLUSION: MRI enabled detection of EIPMT with substantial observer agreement. Patients with EIPMT show a high tendency for fibrotic scar tissue proliferation in the rotator interval.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Rotator Cuff/pathology/*radiography ; Shoulder/pathology/radiography ; Tendons/pathology/*radiography ; Young Adult

OBJECTIVE: We observed patients in whom the fluid collection in the right lateral portion of the superior aortic recess on computed tomography (CT) scans mimicked a right anterior mediastinal mass on chest PA radiographs. The purpose of this study was to assess chest PA and CT features of these patients. MATERIALS AND METHODS: All chest PA radiographs and CT scans in 9 patients were reviewed by two radiologists on a consensus basis; for the presence of pleural effusion, pulmonary edema and heart size on chest PA radiographs. For the portion of the fluid collection in the superior aortic recess (SAR), a connection between the right lateral portion of the SAR (rSAR) and posterior portion of the SAR (pSAR) on CT scans, and the distance between the right lateral margin of the rSAR and the right lateral margin of the superior vena cava. RESULTS: Fluid collection in the rSAR on CT scans caused a right anterior mediastinal mass or a bulging contour on chest PA radiographs in all women patients. All patients showed cardiomegaly, five patients had pleural effusion, and two patients had mild pulmonary edema. Further, eight patients showed a connection between the rSAR and the pSAR. CONCLUSION: The characteristic features of these patients are the right anterior mediastinal mass-like opacity due to fluid collection in the rSAR, are bulging contour with a smooth margin and cardiomegaly regardless of pulmonary edema on the chest PA radiographs, and fluid connection between the rSAR and the pSAR on CT scans.
Aged ; Aged, 80 and over ; Aorta, Thoracic/*radiography ; Cardiomegaly/radiography ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Female ; Humans ; Mediastinal Diseases/*radiography ; Middle Aged ; Pleural Effusion/*radiography ; Pulmonary Edema/*radiography ; Radiography, Thoracic/*methods ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

OBJECTIVE: The aim of this study was to evaluate the effect of adding bedside ultrasonography to the diagnostic algorithm for nephrolithiasis on emergency department (ED) length of stay. METHODS: A prospective, randomized, controlled pilot study was conducted from October 2014 to December 2014 with patients with acute flank pain. In the non-ultrasonography group (NUSG), non-contrast computed tomography was selected based on clinical features and hematuria in the urinalysis. In the ultrasonography group (USG), non-contrast computed tomography was selected based on clinical features and hydronephrosis on bedside ultrasonography. The primary outcome was ED length of stay. The secondary outcomes were radiation exposure, amount of analgesics, proportion of patients with diseases other than ureteral calculus, and proportion of patients with unexpected ED revisits within 7 days from the index visit. RESULTS: A total of 103 patients were enrolled (NUSG, 51; USG, 52). The ED length of stay for the USG (89.0 minutes) was significantly shorter than that for the NUSG (163.0 minutes, P<0.001). There were no significant differences between the two groups in the radiation exposure dose (5.29 and 5.08 mSv, respectively; P=0.392), amount of analgesics (P=0.341), proportion of patients with diseases other than ureteral calculus (13.0% and 6.8%, respectively; P=0.486), and proportion of patients with unexpected ED revisits within 7 days from the index visit (7.8% and 9.6%, respectively; P=1.000). CONCLUSION: The use of early bedside ultrasonography for patients with acute flank pain could reduce the ED length of stay without increasing unexpected ED revisits.
Analgesics ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Length of Stay* ; Nephrolithiasis ; Pilot Projects* ; Prospective Studies ; Radiation Exposure ; Renal Colic* ; Ultrasonography* ; Ureteral Calculi ; Ureterolithiasis ; Urinalysis