PURPOSE: To investigate the effects of hydrogen sulfide (H₂S) on the permeability of a cultured human trabecular meshwork cells (HTMC) monolayer and its interaction with nitric oxide (NO).METHODS: After exposing primary cultured HTMCs to 0, 50, 100, and 500 µM sodium hydrogen sulfide (NaHS) for 6 hours, the permeabilities through the HTMC monolayer were measured using a Transwell assay with carboxyfluorescein. The production of NO and eNOS mRNA expression were assessed using the Griess assay and reverse transcription-polymerase chain reaction, respectively. In addition, 0, 1, and 10 µM NaHS and 10 µM sodium nitroprusside (SN) were co-exposed to evaluate the possible synergistic effect of H₂S and NO.RESULTS: Greater than 100 µM NaHS increased the permeability through the HTMC monolayer in a dose-dependent manner (p < 0.05). These increased permeabilities were not accompanied by NO production or eNOS mRNA expression (p > 0.05). When 0, 1, and 10 µM NaHS and 10 µM SN were exposed together, there was no significant change of permeability, NO production, or eNOS mRNA expression (all, p > 0.05).CONCLUSIONS: NaHS at high concentrations increased the permeability of the HTMC monolayer, which was not affected by NO. NaHS at low concentrations did not show a synergistic effect with NO. Thus, H₂S at high concentrations may increase trabecular outflow, which may not be associated with NO.

Purpose: We evaluated the protective effect of trabecular outflow drugs, Rho kinase (ROCK) inhibitors against oxidative stressin trabecular meshwork cells. Methods: Primary-cultured human trabecular meshwork cells (HTMCs) were exposed to ROCK inhibitors at 10 and 20 μMY-27632, ripasudil or fasudil for 24 hours, after pretreatment with 200 μM hydrogen peroxide for 30 min. The cell viabilities andmetabolic activities were assessed using the Trypan Blue dye exclusion test and MTT assay, respectively. Reactive oxygen species(ROS) production was measured using the H2DCFDA assay, and the degree of apoptosis was measured with flow cytometryusing annexin-propidium iodide double staining. Results: In HTMCs, Y-27632 suppressed ROS production. Ripasudil and fasudil increased the metabolic activities and decreasedthe degrees of apoptosis. Fasudil showed the most cytoprotective effects among the three ROCK inhibitors tested. Conclusions Against oxidative stress, ROCK inhibitors decreased apoptosis accompanied by decreased ROS production, especiallyfasudil. ROCK inhibitors may therefore have cytoprotective properties in addition to increasing trabecular outflow.

The publisher and authors would like to draw the reader’s attention to an error in the following article. The author name of “Seon Mi Baek” should be changed to “Sun Mi Baek”.

OBJECTIVE: To evaluate the efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) in a large population.MATERIALS AND METHODS: Cases of 152 biopsy-proven PTMCs from 133 patients who had undergone RFA for PTMC between May 2008 and January 2017 were included in this study. All patients were either of high surgical risk or refused to undergo surgery. They were followed up for at least 6 months after initial RFA. Ultrasonography (US) and computed tomography were performed to evaluate the PTMC and the presence of neck metastasis before treatment. RFA was conducted using an internally cooled thyroid-dedicated electrode system. Follow-up US was performed at 1 week, and 2, 6, and 12 months, after the initial RFA, and then at every 6–12 months. We evaluated serial changes of ablated tumors, newly developed cancers, lymph node (LN) or distant metastasis and complications.RESULTS: Complete disappearance was found in 91.4% (139/152) of ablated tumors. Among the 13 tumors in patients who did not show complete disappearance, no tumor displayed any regrowth of the residual ablated lesion during the follow-up period. The mean follow-up period was 39 months. During the follow-up period, there were no local recurrence, no LN or distant metastasis, and no newly developed thyroid cancers. No patients were referred to surgery. The overall complication rate was 3% (4/133) of patients, including one voice change. There were no life-threatening complications or procedure-related deaths.CONCLUSION: Our results suggest that RFA is an effective and safe option for treating low-risk PTMC patients who are of high surgical risk or refuse surgery.
Catheter Ablation ; Electrodes ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography ; Voice

Anastomotic complications occur after 5% to 20% of operations for rectosigmoid colon cancer. The intestinal perfusion status at the anastomotic site is an important modifiable risk factor, and surgeons should carefully evaluate and optimize the perfusion at the intended site of anastomosis. Indocyanine green (ICG) angiography is a simple noninvasive perfusion assessment modality. The use of ICG angiography is rapidly spreading in the field of colorectal surgery. However, there is debate on its contribution to reducing anastomotic complications. In this review, we discuss the clinical utility and the standardization of ICG angiography. ICG angiography can unequivocally reveal unfavorable perfusion zones and provide quantitative parameters to predict the risk of hypoperfusion-related anastomotic complications. Many studies have demonstrated the clinical utility of ICG angiography for reducing anastomotic complications. Recently, two multicenter randomized clinical trials reported that ICG angiography did not significantly reduce the incidence of anastomotic leakage. Most previous studies have been small-scale single-center studies, and there is no standardized ICG angiography protocol to date.Additionally, ICG angiography evaluations have mostly relied on surgeons’ subjective judgment. For these reasons, it is necessary to establish a standardized ICG angiography protocol and develop a quantitative analysis protocol for the objective assessment. In conclusion, ICG angiography could be useful for detecting poorly perfused colorectal segments to prevent anastomotic leakage after colorectal surgery. An optimized and standardized ICG angiography protocol should be established to improve the reliability of perfusion assessments. In the future, artificial intelligence-based quantitative analyses could be used to easily assess colonic perfusion status.

Anastomotic complications occur after 5% to 20% of operations for rectosigmoid colon cancer. The intestinal perfusion status at the anastomotic site is an important modifiable risk factor, and surgeons should carefully evaluate and optimize the perfusion at the intended site of anastomosis. Indocyanine green (ICG) angiography is a simple noninvasive perfusion assessment modality. The use of ICG angiography is rapidly spreading in the field of colorectal surgery. However, there is debate on its contribution to reducing anastomotic complications. In this review, we discuss the clinical utility and the standardization of ICG angiography. ICG angiography can unequivocally reveal unfavorable perfusion zones and provide quantitative parameters to predict the risk of hypoperfusion-related anastomotic complications. Many studies have demonstrated the clinical utility of ICG angiography for reducing anastomotic complications. Recently, two multicenter randomized clinical trials reported that ICG angiography did not significantly reduce the incidence of anastomotic leakage. Most previous studies have been small-scale single-center studies, and there is no standardized ICG angiography protocol to date.Additionally, ICG angiography evaluations have mostly relied on surgeons’ subjective judgment. For these reasons, it is necessary to establish a standardized ICG angiography protocol and develop a quantitative analysis protocol for the objective assessment. In conclusion, ICG angiography could be useful for detecting poorly perfused colorectal segments to prevent anastomotic leakage after colorectal surgery. An optimized and standardized ICG angiography protocol should be established to improve the reliability of perfusion assessments. In the future, artificial intelligence-based quantitative analyses could be used to easily assess colonic perfusion status.

A 63 year-old female was brought to our hospital with severe lower back pain. She received antihypertensive drugs for 2 years but her blood pressure was normal upon arrival. She could not stand up or even walk. The MRI showed a subdural hematoma at the thoracolumbar region, which was extremely rare. The treatment applied was decompression through a spinal tap without surgery. After this, her pain subsided considerably. Two weeks later, MRI confirmed that there was no hematoma in the same region. She was discharged and has enjoyed her daily activities free of pain. A spontaneous subdural hematoma is an extremely rare disease. The condition was treated successfully in a conservative manner.
Antihypertensive Agents ; Blood Pressure ; Decompression ; Female ; Hematoma ; Hematoma, Subdural ; Humans ; Low Back Pain ; Rare Diseases ; Spinal Puncture

PURPOSE: The purpose of this study was to observe and compare the changes in the patterns of hemodynamic and blood profiles on the circuit of Extra-corporeal life support system (ECLS) by using a dual pulsatile pump (T-PLS). METHODS: An acute heart failure model using partial pulmonary artery banding was constructed in 12 piglets (20 -25kg). The animals were divided into centrifugal (n=6) and dual pulsatile pump (n=6) group. Each animal was placed on an ECLS system with a membrane oxygenator bypassing the right atrium and the aorta for 2 hours under general anesthesia. The parameters mainly observed were intra-circuit pressure changes, arterial pulsatility (pulse pressure), plasma free hemoglobin, hemodynamic changes, and other blood profiles. The parameters obtained just prior to the bypass were compared with the corresponding parameters obtained two hours after the bypass. RESULTS: Before bypass, the parameters were statistically the same between the groups. Two hours after the bypass, no significant differences were observed between the groups in ABGA, VBGA, AST/ALT, BUN/Cr, and electrolytes; the plasma free hemoglobin was 14.8+/-4.7 g/dl in the dual pulsatile group and 19.1+/-9.1 g/dl in the centrifugal group (p=NS). The pulse pressure was higher in the dual pulsatile pump than in the centrifugal pump group (35+/-8 vs. 11+/-7 mmHg, p=0.0253 mmHg). The highest circuit pressure was generated at the inlet of the membrane oxygenator and was higher in the dual pulsatile group than in the centrifugal group (173+/-12 mmHg vs. 222+/-8 mmHg, p=0.0000). CONCLUSION: The results demonstrate that a dual pulsating mechanism lessens blood cell trauma while providing physiologic pulsatile blood flow. The ECLS system using a dual pulsatile pump (T-PLS) can be useed as an effective and safe driving motor for an ECLS.
Anesthesia, General ; Animals ; Aorta ; Bays ; Blood Cells ; Blood Pressure ; Cardiopulmonary Resuscitation ; Electrolytes ; Heart Atria ; Heart Failure ; Hemodynamics ; Life Support Systems* ; Oxygenators, Membrane ; Plasma ; Pulmonary Artery

BACKGROUND: Diastolic function can be assessed by Doppler-derived left ventricular(LV) filling patterns. E/A ratio<1 and prolongation of isovolumic relaxation time(IVRT) are diagnostic of impaired relaxation of left ventricle during diastole. In early stage of acute myocardial infarction, myocardial stiffness can normalize the E/A ratio and mask the Doppler indexes of abnormal relaxation in patients with acute myocardial infarction. METHODS: LV filling patterns were studied with Doppler echocardiography in 10 healthy subjects and 27 patients with recent acute myocardial infarction. Cardiac catherterization was performed in the 11+/-2 days after onset of acute myocardial infarction and left ventricular end-diastolic pressure(LVEDP) and myocardial stiffiness index(MSI) were studied. RESULTS: In patients with acute myocardial infarction, IVRT was significantly prolonged ; E/A ratio and deceleration time were decreased but not significantly different from those of normal subjects. In the patient's group of E/A>1,IVRT and atrial filling fraction(AFF) were significantly shortened, and LVEDP was significantly increased, compared to those of the patient's group of E/A<1. But ejection fraction was similar in both groups. In the patients with acute myocardial infarction, E/A ratio and LVEDP showed good correlation(r=0.64, p<0.05). MSI was increased in the patient's group of E/A>1 and also was well correlated with LVEDP(r=0.8, p<0.05). CONCLUSIONS: Thus we conclude that normal of increased E/A ratio in recent acute myocardial infarction may reflect increased LVEDP due to increased myocardial stiffness.
Deceleration ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Heart Ventricles ; Humans ; Masks ; Myocardial Infarction* ; Relaxation

BACKGROUND/AIMS: Grape seed proanthocyanidin extract (GSPE) has been reported to have a beneficial effect on regulating inf lammation. However, the anti-inflammatory mechanism of GSPE remains unclear. The aim of this study was to verify the influence of GSPE on the Toll-like receptor 4 (TLR4)-mediated signaling pathway in the regulation of murine autoimmune arthritis. METHODS: Collagen-induced arthritis (CIA) was induced in dilute brown non-agouti (DBA)/1J mice. The mice were treated with GSPE (0 or 100 mg/kg) intraperitoneally. The severity of arthritis was assessed clinically, biochemically, and histologically. Immunostaining for TLR4 was performed. The expressions of TLR4 and downstream signaling molecules were analyzed by Western blot. The effect of GSPE on lipopolysaccharide (LPS)-induced TLR4 activation was also evaluated using RAW264.7 cells and fibroblast-like synoviocytes (FLSs) from patients with rheumatoid arthritis and from those with osteoarthritis. RESULTS: GSPE attenuated the clinical severity of arthritis and decreased histological damage. GSPE treatment reduced the number of TLR4-stained cells in the synovium of mice with CIA. GSPE also downregulated the expression of TLR4, myeloid differentiation factor 88 (MyD88) and phosphorylated IκBα synovial protein in CIA mice. Concurrently, GSPE inhibited the nuclear translocation of nuclear factor-κB (NF-κB) subunits (p65 and p50). LPS-induced TLR4 activation was suppressed by GSPE in human FLS as well as in murine macrophages in vitro. CONCLUSIONS: Our results demonstrated that GSPE ameliorated CIA by regulating the TLR4-MyD88-NF-κB signaling pathway.
Animals ; Arthritis* ; Arthritis, Experimental ; Arthritis, Rheumatoid ; Blotting, Western ; Humans ; In Vitro Techniques ; Macrophages ; Mice ; Myeloid Differentiation Factor 88 ; Osteoarthritis ; Synovial Membrane ; Toll-Like Receptor 4 ; Vitis*