The patients with diabetes are treated with a variety of regimens and are scheduled for surgery at varying times of the day, there is no established consensus for optimal preoperative management. Perioperative glycemic control has a significant impact on the risk of infectious complications - including pneumonia, wound infection, urinary tract infection and sepsis - in patients with diabetes undergoing a variety of surgical procedures. Therefore, the goal of preoperative glycemic control is to avoid hypoglycemia, excessive hyperglycemia, lipolysis, protein catabolism, electrolyte disturbance and ketoacidosis. However, the effects of preoperative glycemic control are not definitive. Patients with type 1 diabetes should receive insulin replacement, while those with type 2 diabetes may need to discontinue oral medications prior to surgery and might require insulin therapy to maintain blood glucose control. The actual treatment should be individualized for each patient, based on diabetes classification, usual diabetes regimen, state of glycemic control, and extent of the surgical procedure. Medical judgment should override these recommendations as needed. Whenever possible, metabolic abnormalities should be corrected, and surgery should be scheduled early in the day.
Blood Glucose ; Consensus ; Diabetes Mellitus ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin ; Judgment ; Ketosis ; Lipolysis ; Pneumonia ; Preoperative Care ; Sepsis ; Urinary Tract Infections ; Wound Infection

Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action. Recently, there have been many case reports that overuse or misuse of fentanyl patch resulted in fatal intoxication. Delayed hypoxic leukoencephalopathy typically manifests 2 to 40 days after apparent recovery from hypoxic event, and patients suffer from cognitive impairment, upper motor neuron signs, gait disturbance, or psychosis. We report first case of delayed encephalopathy with psychotic symptoms after overuse of fentanyl patch. Patient was found to have respiratory failure and mental change due to transdermal fentanyl overdose. She made a complete recovery in 2 weeks. After 4 weeks of the event, she readmitted with declining mental status. At 30 weeks after overdose, she complained of auditory and visual hallucination and showed paranoid delusion and odd behavior. Since admission into psychiatric unit, her psychotic symptoms have improved with antipsychotics. In conclusion, fentanyl patch should be used in order to prevent psychotic symptoms as well as medical complications.
Antipsychotic Agents ; Delusions ; Fentanyl* ; Gait ; Hallucinations ; Humans ; Leukoencephalopathies ; Motor Neurons ; Psychotic Disorders* ; Respiratory Insufficiency

Kinesin-13 (Kin-13), a depolymerizer of microtubule (MT), has been known to affect the length of Giardia. Giardia Kin-13 (GlKin-13) was localized to axoneme, flagellar tips, and centrosomes, where phosphorylated forms of Giardia polo-like kinase (GlPLK) were distributed. We observed the interaction between GlKin-13 and GlPLK via co-immunoprecipitation using transgenic Giardia cells expressing Myc-tagged GlKin-13, hemagglutinin-tagged GlPLK, and in vitro-synthesized GlKin-13 and GlPLK proteins. In vitro-synthesized GlPLK was demonstrated to auto-phosphorylate and phosphorylate GlKin-13 upon incubation with [γ-32P]ATP. Morpholino-mediated depletion of both GlKin-13 and GlPLK caused an extension of flagella and a decreased volume of median bodies in Giardia trophozoites. Our results suggest that GlPLK plays a pertinent role in formation of flagella and median bodies by modulating MT depolymerizing activity of GlKin-13.

Giardia lamblia is a protozoan that causes diarrheal diseases in humans. Cytoskeletal structures of Giardia trophozoites must be finely reorganized during cell division. To identify Giardia proteins which interact with microtubules (MTs), Giardia lysates were incubated with in vitro-polymerized MTs and then precipitated by ultracentifugation. A hypothetical protein (GL50803_8405) was identified in the precipitated fraction with polymerized MTs and was named GlMBP1 (G. lamblia microtubule-binding protein 1). Interaction of GlMBP1 with MTs was confirmed by MT binding assays using recombinant GlMBP1 (rGlMBP1). In vivo expression of GlMBP1 was shown by a real-time PCR and western blot analysis using anti-rGlMBP1 antibodies. Transgenic G. lamblia trophozoites were constructed by integrating a chimeric gene encoding hemagglutinin (HA)-tagged GlMBP1 into a Giardia chromosome. Immunofluorescence assays of this transgenic G. lamblia, using anti-HA antibodies, revealed that GlMBP1 mainly localized at the basal bodies, axonemes, and median bodies of G. lamblia trophozoites. This result indicates that GlMBP1 is a component of the G. lamblia cytoskeleton.
Antibodies ; Axoneme ; Basal Bodies ; Blotting, Western ; Cell Division ; Cytoskeleton ; Fluorescent Antibody Technique ; Giardia lamblia* ; Giardia* ; Hemagglutinins ; Humans ; Microtubules ; Polymers ; Real-Time Polymerase Chain Reaction ; Trophozoites

Complications increases when crown height space is excessive and one should be careful of choosing type of fixed prosthesis in case crown height space is over 12 mm. In this condition, tooth seems to be longer, therefore, it is needed to use gingival shade in aesthetically important area for fixed prosthesis. In this case, fixed prosthesis which has inappropriate maintenance and hygiene could hold food, plaque, calculus, thus increase incidence of inflammation and infection. Moreover, it could lead to chronic inflammation and infection and in that case surgical improvement could be necessary. In present case report, gingival inflammation and swelling developed around prosthesis after having made it considering articulation and aesthetic view in patient who had excessive crown height space. Finding out that design of prosthesis is a factor to make it hard to maintain oral hygiene, a temporary prosthesis which has enough interproximal space and proper emergence profile was fabricated. After two months of observation, significant abnormal symptoms are not found and oral reconstruction is performed using fixed prosthesis with zircornia infrastructure and porcelain build-up based on convenient self hygiene design. Through serial treatment, inappropriate soft tissue response is not observed and satisfactory result in functional aspect comes out.
Calculi ; Crowns ; Dental Porcelain ; Humans ; Hygiene ; Incidence ; Inflammation ; Oral Hygiene ; Prostheses and Implants ; Tooth

Nocardia species are aerobic, gram-positive pathogens found worldwide in soil. Nocardia is considered an opportunistic pathogen, and its infection mostly occurs in immunocompromised patients. We report a case of Nocardia farcinica induced mediastinitis and pneumonia that occurred in a 64-year-old male patient who had no significant medical history except for hypertension. He visited another hospital with a complaint of dyspnea and left chest wall pain. The symptoms arose 7 days ago without any trauma and they worsened. A mediastinal mass was found on computed tomography scan. After being transferred to our hospital for further evaluation, he was diagnosed with mediastinitis and pneumonia. As N. farcinica was found to be the causative organism by 16S rRNA sequencing, proper antibiotic therapy including trimethoprim/sulfamethoxazole was initiated immediately. After this, the patient improved and he was discharged. If an infection has a disseminating course, nocardiosis cannot be excluded even in immunocompetent patients. Once the diagnosis is established, prompt antibiotic therapy should be performed based on the severity.
Diagnosis ; Dyspnea ; Humans ; Hypertension ; Immunocompromised Host ; Male ; Mediastinitis* ; Middle Aged ; Nocardia Infections ; Nocardia* ; Pneumonia* ; Soil ; Thoracic Wall

To identify the component(s) involved in cell cycle control in the protozoan Giardia lamblia, cells arrested at the G1/S- or G2-phase by treatment with nocodazole and aphidicolin were prepared from the synchronized cell cultures. RNA-sequencing analysis of the 2 stages of Giardia cell cycle identified several cell cycle genes that were up-regulated at the G2-phase. Transcriptome analysis of cells in 2 distinct cell cycle stages of G. lamblia confirmed previously reported components of cell cycle (PcnA, cyclin B, and CDK) and identified additional cell cycle components (NEKs, Mad2, spindle pole protein, and CDC14A). This result indicates that the cell cycle machinery operates in this protozoan, one of the earliest diverging eukaryotic lineages.
Aphidicolin ; Cell Culture Techniques ; Cell Cycle ; Cell Cycle Checkpoints ; Cyclin B ; Gene Expression Profiling ; Genes, cdc ; Giardia lamblia ; Giardia ; Nocodazole ; Spindle Poles

MYB2 protein was identified as a transcription factor that showed encystation-induced expression in Giardia lamblia. Although nuclear import is essential for the functioning of a transcription factor, an evident nuclear localization signal (NLS) of G. lamblia MYB2 (GlMYB2) has not been defined. Based on putative GlMYB2 NLSs predicted by 2 programs, a series of plasmids expressing hemagglutinin (HA)-tagged GlMYB2 from the promoter of G. lamblia glutamate dehydrogenase were constructed and transfected into Giardia trophozoites. Immunofluorescence assays using anti-HA antibodies indicated that GlMYB2 amino acid sequence #507–#530 was required for the nuclear localization of GlMYB2, and this sequence was named as NLSGlMYB2. We further verified this finding by demonstrating the nuclear location of a protein obtained by the fusion of NLSGlMYB2 and G. lamblia glyceraldehyde 3-phosphate dehydrogenase, a non-nuclear protein. Our data on GlMYB2 will expand our understanding on NLSs functioning in G. lamblia.

MYB2 protein was identified as a transcription factor that showed encystation-induced expression in Giardia lamblia. Although nuclear import is essential for the functioning of a transcription factor, an evident nuclear localization signal (NLS) of G. lamblia MYB2 (GlMYB2) has not been defined. Based on putative GlMYB2 NLSs predicted by 2 programs, a series of plasmids expressing hemagglutinin (HA)-tagged GlMYB2 from the promoter of G. lamblia glutamate dehydrogenase were constructed and transfected into Giardia trophozoites. Immunofluorescence assays using anti-HA antibodies indicated that GlMYB2 amino acid sequence #507–#530 was required for the nuclear localization of GlMYB2, and this sequence was named as NLSGlMYB2. We further verified this finding by demonstrating the nuclear location of a protein obtained by the fusion of NLSGlMYB2 and G. lamblia glyceraldehyde 3-phosphate dehydrogenase, a non-nuclear protein. Our data on GlMYB2 will expand our understanding on NLSs functioning in G. lamblia.

Intraflagellar transport (IFT) particles, a multi-protein apparatus composed of complex A and B, are known to be involved in homeostasis of flagella formation. IFT particles have recently become an interesting topic in Giardia lamblia, which has 4 pairs of flagella. In this experiment, we examined the function of giardial IFT components. When 7 components (IFT121, 140, 20, 46, 52, 81, and 88) of IFT were expressed in Giardia trophozoites as a tagged form with mNeonGreen, all of them were found in both flagella pores and cytoplasmic axonemes. In addition, motor proteins for IFT particles (kinesin-13 and kinesin-2b), were localized to a median body and cytoplasmic flagella, respectively. The CRISPRi-mediated knockdown of IFT88 significantly affected the lengths of all 4 flagella compared to the control cells, Giardia expressing dead Cas9 using control guide RNA. Decreased expression of kinesin-2b also resulted in shortening of flagella, excluding the ventral flagella. Live Giardia cells expressing IFT88-mNeonGreen clearly demonstrated fluorescence in flagella pores and cytoplasmic axonemes. These results on IFT88 and kinesin-2b indicate that IFT complex plays a role in maintenance of G. lamblia flagella.