Parkinson's disease is an age-related, slowly progressing neurodegenerative disorder characterized by abnormal deposition of aggregated alpha-synuclein in neuronal cell bodies (Lewy bodies) and neurites (Lewy neurites), as well as in glia. Based on semiquantitative assessment of Lewy pathologies in autopsy samples, a staging system was proposed indicating a highly predictable sequence of pathological progression. This staging system implicates a propagation of alpha-synuclein aggregation throughout the brain with an ascending pattern from lower brain stem to neocortex. The underlying mechanism for the pathological propagation is unknown. However, the recent discoveries on the secretion of neuronal alpha-synuclein and subsequent uptake of the protein by neighboring cells propose an interneuronal transmission of alpha-synuclein aggregates as a novel mechanism for the spread of Lewy pathology in PD. Elucidation of this mechanism is likely to identify novel therapeutic strategies that halt the progression of PD.
alpha-Synuclein ; Autopsy ; Brain ; Brain Stem ; Endocytosis ; Exocytosis ; Interneurons ; Lewy Bodies ; Neocortex ; Neurites ; Neurodegenerative Diseases ; Neuroglia ; Neurons

Enhanced recovery after surgery (ERAS) is a multimodal and multidisciplinary approach to maintaining physiologic function and improving recovery for surgical patients. The ERAS protocol is based on a range of empirical evidence, and consensus ERAS guidelines for various surgical procedures have been published. The elements of the ERAS protocol include minimal preoperative fasting and carbohydrate treatment instead of overnight fasting; no routine use of preoperative bowel preparation; minimally invasive surgical techniques; standard anesthetic protocol; optimal fluid management rather than generous intravenous fluid administration; prevention and treatment of postoperative nausea and vomiting; active prevention of perioperative hypothermia; multimodal approaches to controlling postoperative pain; and early oral intake and mobilization. Implementation of ERAS shortened hospital stays by 30% to 50% and reduced postoperative complications by 50%. A recent study reported that, when patient compliance with the colorectal ERAS protocol was over 70%, 5-year mortality fell by 42% compared with when compliance was below 70%. Auditing process compliance and patient outcomes are key measures for assisting clinicians implementing the ERAS program. As a perioperativist, an anesthesiologist can play a crucial role in implementing the ERAS program and contribute to protocol establishment, auditing, team education and team leadership. While the ERAS protocol was first implemented for colorectal surgery, as a result of its efficacy, it is now being used in nearly all major surgical specialties.
Colorectal Surgery ; Compliance ; Consensus ; Education ; Fasting ; Humans ; Hypothermia ; Leadership ; Length of Stay ; Mortality ; Pain, Postoperative ; Patient Compliance ; Postoperative Complications ; Postoperative Nausea and Vomiting ; Specialties, Surgical

BACKGROUND: Accurate, rapid, and cost-effective screening tests for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection may be useful in laboratories that cannot afford automated chemiluminescent immunoassays (CLIAs). We evaluated the diagnostic performance of a novel rapid automated fluorescent lateral flow immunoassay (LFIA). METHODS: A fluorescent LFIA using a small bench-top fluorescence reader, Automated Fluorescent Immunoassay System (AFIAS; Boditech Med Inc., Chuncheon, Korea), was developed for qualitative detection of hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and antibody to HCV (anti-HCV) within 20 minutes. We compared the diagnostic performance of AFIAS with that of automated CLIAs—Elecsys (Roche Diagnostics GmbH, Penzberg, Germany) and ARCHITECT (Abbott Laboratories, Abbott Park, IL, USA)—using 20 seroconversion panels and 3,500 clinical serum samples. RESULTS: Evaluation with the seroconversion panels demonstrated that AFIAS had adequate sensitivity for HBsAg and anti-HCV detection. From the clinical samples, AFIAS sensitivity and specificity were 99.8% and 99.3% for the HBsAg test, 100.0% and 100.0% for the anti-HBs test, and 98.8% and 99.1% for the anti-HCV test, respectively. Its agreement rates with the Elecsys HBsAg, anti-HBs, and anti-HCV detection assays were 99.4%, 100.0%, and 99.0%, respectively. AFIAS detected all samples with HBsAg genotypes A-F and H and anti-HCV genotypes 1, 1a, 1b, 2a, 2b, 4, and 6. Cross-reactivity with other infections was not observed. CONCLUSIONS: The AFIAS HBsAg, anti-HBs, and anti-HCV tests demonstrated diagnostic performance equivalent to current automated CLIAs. AFIAS could be used for a large-scale HBV or HCV screening in low-resource laboratories or low-to middle-income areas.
Fluorescence ; Gangwon-do ; Genotype ; Hepacivirus ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Hepatitis B* ; Hepatitis C* ; Hepatitis* ; Immunoassay* ; Mass Screening ; Sensitivity and Specificity ; Seroconversion

Purpose: Even though pazopanib, a multitargeted tyrosine kinase inhibitor, has been approved for refractory soft tissue sarcoma (STS), little is known about the molecular determinants of the response to pazopanib. We performed integrative molecular characterization to identify potential predictors of pazopanib efficacy. Materials and Methods: We obtained fresh pre-treatment tumor tissue from 35 patients with advanced STS receiving pazopanib-based treatment. Among those, 18 (51.4%) received pazopanib monotherapy, and the remaining 17 (48.6%) received pazopanib in combination with durvalumab, programmed death-ligand 1 blockade. Whole-exome and transcriptome sequencing were performed for each tumor and patient germline DNA. Results: Of the 35 patients receiving pazopanib-based treatment, nine achieved a partial response (PR), resulting in an objective response rate (ORR) of 27.3%, and the median progression-free survival (PFS) was 6.0 months. Patients with CDK4 amplification (copy ratio tumor to normal > 2) exhibited shorter PFS (3.7 vs. 7.9 months, p=2.09×10–4) and a poorer response (ORR; 0% vs. 33.3%) compared to those without a gene amplification (copy ratio ≤ 2). Moreover, non-responders demonstrated transcriptional activation of CDK4 via DNA amplification, resulting in cell cycle activation. In the durvalumab combination cohort, seven of the 17 patients (41.2%) achieved a PR, and gene expression analysis revealed that durvalumab responders exhibited high immune/stromal cell infiltration, mainly comprising natural killer cells, compared to non-responders as well as increased expression of CD19, a B-cell marker. Conclusion Despite the limitation of heterogeneity in the study population and treatment, we identified possible molecular predictors of pazopanib efficacy that can be employed in future clinical trials aimed at evaluating therapeutic strategies.