Prolonged ischemia results in cellular necrosis and only prompt restoration of blood flow will prevent this type of injury. However, reperfusion itself can cause significant injury of previously ischemic tissue, i.e. "reperfusion injury'. This is an issue of concern in many areas of reconstructive surgery including free tissue transfer and replantation. Many factors have been implicated in the cause of reperfusion injury. Oxygen free radicals have enjoyed increasing popularity recently, but leukocytes had been thought to have a role only in the healing process that follows ischemic injury. Current studies in myocardium, liver and intestine have shown a dramatic increase in tissue leukocytes after ischemia-reperfusion and evidence implicating leukocytes in pathogenesis of ischemia-reperfusion injury has come from studies demonstrating significant injury reduction by depletion of circulating neutrophils. Therefore, increased neutrophil adhesiveness is a critical early step in the sequence of events leading to neutrophil-mediated injury. The purpose of this study is to evaluate the effect of CDl8 monoclonal antibody(CDl8 mAb), blocking antibody of neutrophil adherence, and superoxide dismutase (SOD), free radical scavenger, on reperfusion injury in rat epigastric island skin flap. The epigastric pedicle was occluded for six hours with ambient temperature at 22+/-1degrees C. The epigastric nerve was carefully dissected out and left intact to minimize autocannibalization. The flaps were sutured back down to their beds over interposed silicone sheets to prevent plasmatic imbibition. Fifteen minutes before reperfusion, the flaps were perfused with saline, CDl8 mAb(1 mg/kg), SOD(20,000 unit/kg) or CDl8 mAh/SOD(1 mg/kg + 20,000unit/kg). Percentage of flap survival was assessed by computerized planimetry on the seventh day. Tissue biopsies for myeloperoxidase(MPO) and malonyldialdehyde (MDA) were obtained at 24 hours after reperfusion. The results were as follows. 1. Percentage of flap survival was significantly increased in CDl8 mAb/SOD, CDl8 mAb and SOD groups in order, compared to the control(P < 0.05). Percentage of flap survival was significantly increased in CDl8 mAb group as compared with SOD group(p < 0.05). Percentage of flap survival significantly increased in CDl8 mAb/SOD group as compared with CDl8 mAb and SOD groups(p < 0.05) 2. MPO activity was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups(p < 0.01). MPO activity was significantly decreased in CDl8 mAb group as compared with SOD group. (p < 0.01). 3. MDA content was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups (p < 0.01), but the difference between CDl8 mAb and SOD groups was not significant. From those above results, we get to the conclusion that blocking neutrophil adherence and/or aggregation with monoclonal antibodies to CDl8 as compared with radical scavenger significantly ameliorates reperfusion injury. It is suggested that combination of modalities with antiadhesion therapy and radical scavenger may have a synergistic effect of improving flap survival and may be the optimal prevention of ischemiareperfusion injury.
Adhesiveness ; Animals ; Antibodies, Monoclonal ; Biopsy ; Free Radicals ; Intestines ; Ischemia ; Leukocytes ; Liver ; Malondialdehyde ; Myocardium ; Necrosis ; Neutrophils ; Oxygen ; Rats ; Reperfusion Injury* ; Reperfusion* ; Replantation ; Silicones ; Skin ; Superoxide Dismutase* ; Superoxides*

Prolonged ischemia results in cellular necrosis and only prompt restoration of blood flow will prevent this type of injury. However, reperfusion itself can cause significant injury of previously ischemic tissue, i.e. "reperfusion injury'. This is an issue of concern in many areas of reconstructive surgery including free tissue transfer and replantation. Many factors have been implicated in the cause of reperfusion injury. Oxygen free radicals have enjoyed increasing popularity recently, but leukocytes had been thought to have a role only in the healing process that follows ischemic injury. Current studies in myocardium, liver and intestine have shown a dramatic increase in tissue leukocytes after ischemia-reperfusion and evidence implicating leukocytes in pathogenesis of ischemia-reperfusion injury has come from studies demonstrating significant injury reduction by depletion of circulating neutrophils. Therefore, increased neutrophil adhesiveness is a critical early step in the sequence of events leading to neutrophil-mediated injury. The purpose of this study is to evaluate the effect of CDl8 monoclonal antibody(CDl8 mAb), blocking antibody of neutrophil adherence, and superoxide dismutase (SOD), free radical scavenger, on reperfusion injury in rat epigastric island skin flap. The epigastric pedicle was occluded for six hours with ambient temperature at 22+/-1degrees C. The epigastric nerve was carefully dissected out and left intact to minimize autocannibalization. The flaps were sutured back down to their beds over interposed silicone sheets to prevent plasmatic imbibition. Fifteen minutes before reperfusion, the flaps were perfused with saline, CDl8 mAb(1 mg/kg), SOD(20,000 unit/kg) or CDl8 mAh/SOD(1 mg/kg + 20,000unit/kg). Percentage of flap survival was assessed by computerized planimetry on the seventh day. Tissue biopsies for myeloperoxidase(MPO) and malonyldialdehyde (MDA) were obtained at 24 hours after reperfusion. The results were as follows. 1. Percentage of flap survival was significantly increased in CDl8 mAb/SOD, CDl8 mAb and SOD groups in order, compared to the control(P < 0.05). Percentage of flap survival was significantly increased in CDl8 mAb group as compared with SOD group(p < 0.05). Percentage of flap survival significantly increased in CDl8 mAb/SOD group as compared with CDl8 mAb and SOD groups(p < 0.05) 2. MPO activity was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups(p < 0.01). MPO activity was significantly decreased in CDl8 mAb group as compared with SOD group. (p < 0.01). 3. MDA content was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups (p < 0.01), but the difference between CDl8 mAb and SOD groups was not significant. From those above results, we get to the conclusion that blocking neutrophil adherence and/or aggregation with monoclonal antibodies to CDl8 as compared with radical scavenger significantly ameliorates reperfusion injury. It is suggested that combination of modalities with antiadhesion therapy and radical scavenger may have a synergistic effect of improving flap survival and may be the optimal prevention of ischemiareperfusion injury.
Adhesiveness ; Animals ; Antibodies, Monoclonal ; Biopsy ; Free Radicals ; Intestines ; Ischemia ; Leukocytes ; Liver ; Malondialdehyde ; Myocardium ; Necrosis ; Neutrophils ; Oxygen ; Rats ; Reperfusion Injury* ; Reperfusion* ; Replantation ; Silicones ; Skin ; Superoxide Dismutase* ; Superoxides*

BACKGROUND: Although insulin resistance and decreased insulin secretion are characteristics of established type 2 DM, which of these metabolic abnormalities is the primary determinant of type 2 DM is controversial. It is also not well known how insulin resistance and beta cell dysfunction influence serum insulin, proinsulin, proinsulin/insulin ratio in type 2 DM. METHODS: We compared serum insulin, proinsulin and proinsulin/insulin ratio in type 2 diabetic patients and control subjects. We also investigated the relationship between serum insulin, proinsulin and proinsulin/insulin ratio and several biochemical markers which represent insulin resistance or beta cell function. RESULTS: Insulin, proinsulin and proinsulin/insulin ratio were significantly higher in type 2 DM than control(p < 0.001). In diabetic patients, total insulin level was correlated with urinary albumin excretion rates(r = 0.224, p = 0.025) and body mass index(r = 0.269, p = 0.014). Proinsulin level was correlated with fasting C-peptide(r = 0.43, p = 0.002), postprandial 2 hour blood glucose(r = 0.213, p = 0.05) and triglyceride(r = 0.28, p = 0.022). Proinsulin/insulin ratio was positively correlated with fasting C-peptide(r = 0.236, p = 0.031), fasting blood glucose (r = 0.264, p = 0.015), postprandial 2 hour blood glucose(r = 0.277, p = 0.001) and triglyceride(r = 0.428, p < 0.001). In control subjects, insulin level was correlated with triglyceride(r = 0.366, p = 0.002). Proinsulin/insulin ratio was correlated with age(r = 0.241, p = 0.044). CONCLUSION: The serum levels of insulin and proinsulin seem to be associated with several markers of insulin resistance. Whereas proinsulin/insulin ratio might represent beta cell function rather than insulin resistance. But more studies are needed to clarify the mechanisms of elevated proinsulin/insulin ratio in type 2 DM.
Aged ; Diabetes Mellitus, Non-Insulin-Dependent/etiology ; Diabetes Mellitus, Non-Insulin-Dependent/blood* ; Female ; Human ; Insulin/blood* ; Insulin Resistance* ; Islets of Langerhans/physiopathology* ; Male ; Middle Age ; Proinsulin/blood* ; Sulfonylurea Compounds/pharmacology

The implatnation of malignant cells along the needle tract is an extremely rare complication after a percutaneous fine-needle aspiration biopsy(FNAB). However, it is very serious and may result in a change in the prognosis of lung cancer, especially in the curable early stage(T1-2,N0,M0). Recently, we experienced two cases of such complications. A 43 years old female underwent a fine needle aspiration biopsy and a right middle lobectomy with adjuvant chemotherapy due to an adenocarcinoma(T2N0M0). Two years later, a new tumor developed at the site of the needle aspiration biopsy. It had the same pathological findings as the previous lung cancer. Therefore, it was concluded to be an implantation metastasis, and she was treated successfully by a right pneumonectomy and a resection of the chest wall mall with adjuvant radiotherapy. In another case, a 62 years old man was diagnosed with squamous cell lung cancer by a fine needle aspiration biopsy and underwent a right upper lobectomy(T2N0M0) with adjuvant chemotherapy. eight months later, a protruding chest wall mass developed at the aspiration site. It showed the same pathological findings as the previous lung cancer. Consequently, a total excision of the mass with adjuvant radiotherapy was done. Two years after the second operation, although the right lung was intace a metachronous squamous cell lung cancer was found at the left lower lobe. The two patients were still alive 15 and 37 months after thenresection of the chest wall mass, respectively.
Biopsy ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Chemotherapy, Adjuvant ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Needles ; Neoplasm Metastasis* ; Pneumonectomy ; Prognosis ; Radiotherapy, Adjuvant ; Thoracic Wall* ; Thorax*

OBJECTIVE: Miniscrew-assisted rapid palatal expansion (MARPE) is a means for expanding the basal bone without surgical intervention in young adults. Here, we assessed the differences in dental, alveolar, and skeletal measurements taken before (T0), immediately after (T1), and 1 year after (T2) MARPE. METHODS: Twenty-four patients (mean age, 21.6 years) who had undergone MARPE and cone-beam computed tomography at T0, T1, and T2 were included. Changes in the following parameters were compared using paired t-tests: intercusp, interapex, alveolar, nasal floor, and nasal cavity widths; inclination of the first molar (M1) and its alveolus; and thickness and height of the alveolar bone. A linear mixed-effects model was used to determine variables that affected periodontal changes in the M1. RESULTS: MARPE produced significant increases in most measurements during T0–T2, despite relapse of some measurements during T1–T2. The alveolar thickness decreased on the buccal side, but increased on the palatal side. The alveolar crest level at the first premolar moved apically. Changes in the thickness and height of the alveolar bone were affected by the corresponding initial values. CONCLUSIONS: MARPE can be used as an effective tool for correcting maxillomandibular transverse discrepancy, showing stable outcomes 1 year after expansion.
Bicuspid ; Cone-Beam Computed Tomography ; Humans ; Molar ; Nasal Cavity ; Recurrence ; Young Adult

OBJECTIVE: To investigate the changes of apoptosis related factors after denervation and disuse in skeletal muscles and to find out the role of apoptosis in atrophic process. METHOD: 30 male Sprague-Dawley rats, 8 weeks of age were treated with three different atrophy models (10 rats in each group); hind-limbs suspension (HS) as a disuse model, complete denervation by sciatic nerve transsection (CD) and partial denervation by sciatic nerve crushing (PD). At 2 weeks and 4 weeks after each experiment, both gastrocnemius were dissected and their weights were measured. Western blotting for BAX and Bcl-2 and TUNEL assay were used to assess the changes of apoptosis related factors in muscle cell. RESULTS: The muscle weight of PD and CD group decreased 38.6%, 65.6%, respectively, of intact side at 4 weeks after injuries. The loss of muscle weight in HS group was smaller than that of denervated muscles. CD group showed high expression of BAX (3.45+/-0.32-->2.87+/-0.48) and Bcl-2 (3.63+/-0.40-->3.33+/-0.50) at 2 and 4 weeks after denervation, but in PD group, BAX at 2 weeks significantly decreased at 4 weeks (3.40+/-0.55-->2.13+/-0.25). In HS group, their expressions were slightly increased only immediate after 14 days suspension (BAX: 1.30+/-0.38 and Bcl-2: 1.29+/-0.28). CD group showed higher number of positive nuclei (27.6+/-8.8%) than PD group (10.4+/-5.3%) and HS group (4.4+/-1.6%) in TUNEL assay. CONCLUSION: Unlike temporary increase of apoptosis related factors in disuse, increase of these factors are remarkable and persisted after denervation. Muscle apoptosis may be the major cause of muscle atrophy during degeneration process.
Animals ; Apoptosis ; Atrophy ; Blotting, Western ; Denervation ; Humans ; In Situ Nick-End Labeling ; Male ; Muscle Cells ; Muscle, Skeletal ; Muscles ; Muscular Atrophy ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; Weights and Measures

Sarcopenia has been defined as the considerable loss of skeletal muscle mass and strength that results in frailty in the elderly. Because muscle tissue plays diverse important roles in human, sarcopenia presents many negative health-related consequences including impaired energy homeostasis, falls and cardiovascular disease, and subsequently higher mortality. It is becoming evident that sarcopenia has a negative impact on the healthy life of the elderly. The European Working Group on Sarcopenia, the International Working Group on Sarcopenia and the Asian Working Group on Sarcopenia have released position statement regarding sarcopenia, and more recently the Foundation for the National Institutes of Health Sarcopenia Project has provided a new guideline for assessment of sarcopenia. At this time, there have been several data delineating the status of sarcopenia in Korea. This review focuses on largescale cohorts that assessed sarcopenia and highlights the controversies surrounding the clinical definition and prevalence of sarcopenia in Korea.
Aged ; Asian Continental Ancestry Group ; Cardiovascular Diseases ; Cohort Studies ; Homeostasis ; Humans ; Korea ; Mortality ; Muscle, Skeletal ; National Institutes of Health (U.S.) ; Prevalence* ; Sarcopenia*

BACKGROUND: Glycemic variability is associated with the development of diabetic complications through the activation of oxidative stress. This study aimed to evaluate the effects of a dipeptidyl peptidase 4 inhibitor, vildagliptin, or a thiazolidinedione, pioglitazone, on glycemic variability and oxidative stress in patients with type 2 diabetes. METHODS: In this open label, randomised, active-controlled, pilot trial, individuals who were inadequately controlled with metformin monotherapy were assigned to either vildagliptin (50 mg twice daily, n=17) or pioglitazone (15 mg once daily, n=14) treatment groups for 16 weeks. Glycemic variability was assessed by calculating the mean amplitude of glycemic excursions (MAGE), which was obtained from continuous glucose monitoring. Urinary 8-iso prostaglandin F₂α, serum oxidised low density lipoprotein, and high-sensitivity C-reactive protein were used as markers of oxidative stress or inflammation. RESULTS: Both vildagliptin and pioglitazone significantly reduced glycated hemoglobin and mean plasma glucose levels during the 16-week treatment. Vildagliptin also significantly reduced the MAGE (from 93.8±38.0 to 70.8±19.2 mg/dL, P=0.046), and mean standard deviation of 24 hours glucose (from 38±17.3 to 27.7±6.9, P=0.026); however, pioglitazone did not, although the magnitude of decline was similar in both groups. Markers of oxidative stress or inflammation including urinary 8-iso prostaglandin F₂α did not change after treatment in both groups. CONCLUSION: In this 16-week treatment trial, vildagliptin, but not pioglitazone, reduced glycemic variability in individuals with type 2 diabetes who was inadequately controlled with metformin monotherapy, although a reduction of oxidative stress markers was not observed.
Blood Glucose ; C-Reactive Protein ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Dipeptidyl Peptidase 4 ; Dipeptidyl-Peptidase IV Inhibitors ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Inflammation ; Lipoproteins ; Metformin* ; Oxidative Stress* ; Pilot Projects* ; Thiazolidinediones

OBJECTIVE: Our purpose was to review patients undergoing radical hysterectmy and pelvic lymphadenectomy, comparing Pfannenstiel and Vertical midline incisions for operative feasibility and perioperative outcome. METHODS: Between January 2001 and February 2003, 123 patients underwent radical hysterectomy and pelvic lymphadenectomy for cervical cancer at Busan Paik hospital. All procedures were performed by a gynecologic oncologist. Prospectively, all data were collected from review of each patient's medical record, including age, body mass index (BMI), stage, histology, nodal counts, operative time, estimated blood loss, surgical pathologic margin positivity, complications, and length of hospital stay. Associations between variables were studied using X2 test, t-test, and Fisher Exact test. RESULTS: Radical hysterectomy was performed through a Vertical midline (n=62) and Pfannenstiel (n=61) incision. There were no significant differences in age, BMI, stage, histology, nodal counts, estimated blood loss, surgical pathologic margin positivity, complications, and length of hospital stay. But, patients with a Pfannenstiel incision had shorter operative time than those with Vertical midline incision (169 min vs 197 min, P<0.0001). CONCLUSION: Radical hysterectomy and pelvic lymphadenectomy can be safely performed through a Pfannenstiel incision without increased operative morbidity and equal nodal removal as compared with Vertical midline incision. Pfannenstiel incision may offer the benefits of improved cosmesis and shorter operative time without compromising surgical exposure or increasing the risk of surgical complications.
Blood Loss, Surgical ; Body Mass Index ; Busan ; Humans ; Hysterectomy* ; Length of Stay ; Lymph Node Excision* ; Medical Records ; Operative Time ; Prospective Studies ; Uterine Cervical Neoplasms

This paper presents a family with sick sinus syndrome, spanning three generations and with an autosomal dominant trait. The proband was affected by atrial fibrillation with a slow ventricular rhythm that required a permanent pacemaker. Her three sons were affected with a sinus node dysfunction and one daughter died suddenly at the age of 32 years. A pacemaker was implanted in the proband and her two sons with symptoms related to bradycardia. One of her sons with the pacemaker died of a cerebrovascular accident several months later. We report a family with sick sinus syndrome requiring the implantation of a pacemaker with a review of the literature.
Atrial Fibrillation ; Bradycardia ; Family Characteristics ; Humans ; Nuclear Family ; Sick Sinus Syndrome* ; Stroke