In this paper, we analyzed a fictional character from the movie series (James Bond from the 007 series) based on Kohut’s self psychology to understand the formation and evolution of narcissistic personality traits. James Bond experienced sudden parental loss due to a tragic accident. He endured childhood bullying, leading to a deficiency in mirroring selfobject experiences, idealized selfobject experiences, and twinship selfobject experiences. These deficits culminated in his developing narcissistic personality disorder. However, James Bond was able to undergo a process of transmuting internalization through new selfobjects such as M and Madeleine. This enabled him to reactivate disrupted developmental processes and ultimately reach a state of healthy self.

A hospitalist-run acute medical unit (AMU) opened at a tertiary care hospital on August 2015 for the first time in Korea. Patients visiting the emergency department (ED) with acute medical problems are admitted to the AMU. They stay in that unit for less than 72 hours and are discharged or transferred to specialty wards if longer treatment is necessary. We reviewed 19,450 medical admissions through the ED from January 2014 to September 2016. The median length of stay (LOS) significantly decreased from 10.0 days (interquartile range [IQR], 5.5–16.7) to 9.1 days (IQR, 5.1–15.0) (P < 0.001) after the establishment of the AMU. The median waiting time in the ED significantly shortened by 40% (P < 0.001). Future studies on the impact of AMU on in-patient morbidity, mortality, re-admission rate, and patient or staff satisfaction are necessary.
Emergencies* ; Emergency Service, Hospital* ; Hospital Medicine ; Hospitalists ; Humans ; Korea ; Length of Stay* ; Mortality ; Tertiary Healthcare*

It has been found that 4-isopropyl-2,6-bis(1-phenylethyl)phenol (KTH-13), a novel compound isolated from Cordyceps bassiana, is able to suppress tumor cell proliferation by inducing apoptosis. To mass-produce this compound, we established a total synthesis method. Using those conditions, we further synthesized various analogs with structural similarity to KTH-13. In this study, we aimed to test their anti-cancer activity by measuring anti-proliferative and pro-apoptotic activities. Of 8 compounds tested, 4-methyl-2,6-bis(1-phenylethyl)phenol (KTH-13-Me) exhibited the strongest anti-proliferative activity toward MDA-MB 231 cells. KTH-13-Me also similarly suppressed the survival of various cancer cell lines, including C6 glioma, HCT-15, and LoVo cells. Treatment of KTH-13-Me induced several apoptotic signs in C6 glioma cells, such as morphological changes, induction of apoptotic bodies, and nuclear fragmentation and chromatin condensation. Concordantly, early-apoptotic cells were also identified by staining with FITC-Annexin V/PI. Moreover, KTH-13-Me highly enhanced the activation of caspase-3 and caspase-9, and decreased the protein level of Bcl-2. In addition, the phosphorylation levels of Src and STAT3 were diminished in KTH-13-Me-treated C6 cells. Therefore, these results suggest that KTH-13-Me can be developed as a novel anti-cancer drug capable of blocking proliferation, inducing apoptosis, and blocking cell survival signaling in cancer cells.
Apoptosis ; Caspase 3 ; Caspase 9 ; Cell Line ; Cell Proliferation ; Cell Survival ; Chromatin ; Cordyceps ; Extracellular Vesicles ; Glioma ; Methods ; Phosphorylation

PURPOSE: Colorectal obstruction develops most frequently by carcinoma, and 7%–30% of these colorectal carcinomas are acute cases. The oncologic safety of self-expanding metal stent (SEMS) insertion as a bridge to surgery has not yet been established. Thus, we investigated the oncologic safety of SEMS insertion as a bridge to surgery in patients with obstructive colorectal cancer.METHODS: This retrospective had 56 patients enrolled requiring emergency management for obstructive colorectal cancer at stage II or III, who had undergone curative surgery between July 2008 and June 2011. These subjects were divided into two groups: patients who had undergone emergency surgery without SEMS insertion (non-stent group) and those who had undergone elective surgery after preoperative decompression with SEMS insertion (stent group). The two groups were compared for clinicopathologic characteristics, postoperative complications, and survival rate.RESULTS: Enterostomy was performed in 25 patients (100.0%) in the non-stent group and 1 patient (3.2%) in the stent group; laparoscopic surgery was carried out in 7 patients (28.0%) in the non-stent group and 19 patients (61.29%) in the stent group, each showing statistically significant differences. There was no statistically significant difference in postoperative complications and 5-year disease-free survival rate (72% vs. 74.19%, P=0.87, respectively).CONCLUSION: In treatment of malignant colorectal obstruction, elective operation after stent insertion had similar oncologic outcomes compared with emergency operation. Preoperative stent insertion not only lowers the incidence of enterostomy but also makes laparoscopic surgery possible, thereby enhancing patients' quality of life. Therefore, preoperative stent insertion is a useful method that may replace emergency surgery in treatment of malignant colorectal obstruction.
Colorectal Neoplasms ; Decompression ; Disease-Free Survival ; Emergencies ; Enterostomy ; Humans ; Incidence ; Intestinal Obstruction ; Laparoscopy ; Methods ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Stents ; Survival Rate

PURPOSE: The efficacy of stenting for the right-side colonic malignant obstruction is unknown. The purpose of this study was to evaluate the safety and feasibility of self-expandable metallic stent insertion for the right-side colonic malignant obstruction and its clinical benefits. METHODS: We retrospectively reviewed clinical data from 460 patients who underwent right hemicolectomy for right-side colon cancer from January 2006 to January 2014 at Korea University Anam Hospital. Twenty four patients who developed malignant obstruction in the right -side colon were identified and analyzed. RESULTS: Self-expandable metallic stent insertion was attempted in 14 patients, and initial technical success was achieved in 13 patients (92.9%). No immediate stent-related complications were reported. Complete relief of obstruction was achieved in all of the 13 patients. Eleven patients who failed stenting underwent emergency operation. All of the 13 patients with stent underwent laparoscopic surgery and only one case was converted to open. Only three patients in the emergency group underwent laparoscopic surgery but one was converted. Operative time and number of retrieved lymph nodes did not differ between the two groups. Postoperative hospital stay (9.8+/-3.2 in stent group vs. 16.3+/-10.9 days in emergency group, p=0.082) tended to be shorter in the stent group. Estimated blood loss (38.5+/-138.7 in stent group vs. 381.8+/-411.9 in emergency group, p=0.010) and duration for resuming diet (3.2+/-2.2 in stent group vs. 6.6+/-7.0 days in emergency group, p=0.017) were significantly better in the stent group. CONCLUSION: Self-expandable metallic stent appears to be safe and feasible in the right-side colonic malignant obstruction. It facilitates minimally invasive surgery and may result in better short-term surgical outcome.
Colon* ; Colonic Neoplasms ; Diet ; Emergencies ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Retrospective Studies ; Stents* ; Surgical Procedures, Minimally Invasive

Aripiprazole (ARI) is a commonly prescribed medication used to treat schizophrenia and bipolar disorder. To date, there have been no studies regarding the molecular pathological and immunotoxicological profiling of aripiprazole. Thus, in the present study, we prepared two different formulas of aripiprazole [Free base crystal of aripiprazole (ARPGCB) and cocrystal of aripiprazole (GCB3004)], and explored their effects on the patterns of survival and apoptosis-regulatory proteins under acute toxicity and cytotoxicity test conditions. Furthermore, we also evaluated the modulatory activity of the different formulations on the immunological responses in macrophages primed by various stimulators such as lipopolysaccharide (LPS), pam3CSK, and poly(I:C) via toll-like receptor 4 (TLR4), TLR2, and TLR3 pathways, respectively. In liver, both ARPGCB and GCB3004 produced similar toxicity profiles. In particular, these two formulas exhibited similar phospho-protein profiling of p65/nuclear factor (NF)-kappaB, c-Jun/activator protein (AP)-1, ERK, JNK, p38, caspase 3, and bcl-2 in brain. In contrast, the patterns of these phospho-proteins were variable in other tissues. Moreover, these two formulas did not exhibit any cytotoxicity in C6 glioma cells. Finally, the two formulations at available in vivo concentrations did not block nitric oxide (NO) production from activated macrophage-like RAW264.7 cells stimulated with LPS, pam3CSK, or poly(I:C), nor did they alter the morphological changes of the activated macrophages. Taken together, our present work, as a comparative study of two different formulas of aripiprazole, suggests that these two formulas can be used to achieve similar functional activation of brain proteins related to cell survival and apoptosis and immunotoxicological activities of macrophages.
Aripiprazole ; Apoptosis ; Bipolar Disorder ; Brain ; Caspase 3 ; Cell Survival ; Glioma ; Liver ; Macrophages ; Nitric Oxide ; Schizophrenia ; Toll-Like Receptor 4

Since the first clinical application of "the da Vinci system" in 2005 in Korea, robotic surgery, an emerging technology in minimally invasive surgery (MIS), has been rapidly adopted in a variety of surgical fields, and approximately 7,000 robotic surgeries have been performed annually in recent years. In past years, Korean surgeons have played a pivotal role in development of robotic surgery, particularly in the general surgery field. A major advantage of robotic surgery is to make a more precise procedure possible, especially in a confined area with magnified three-dimensional vision, enhanced dexterity by endowrist and stable camera control, and better ergonomics, thus adds the benefits of MIS, such as improvement of oncologic surgery quality and better functional preservation. For these reasons, it has been used prominently in prostate, thyroid, and rectal surgery. However, it is also true that several controversies such as less evidence for efficacy and cost-effectiveness, a longer operation time, and absence of haptic sensation have continued. In this article, we reviewed the current status of robotic surgery mainly based on a report from National Evidence-based Healthcare Collaborating Agency (NECA) and discussed the future prospects on the basis of recent literature and our clinical experiences.
Delivery of Health Care ; Human Engineering ; Korea ; Prostate ; Sensation ; Surgical Procedures, Minimally Invasive ; Thyroid Gland

Hepatitis E virus (HEV) can infect not only human but also several animals. This study has been conducted to evaluate the comprehensive anti-HEV seroprevalence in zoo animals in Korea. Anti-HEV antibodies were identified in 14 of 64 zoo animal species. HEV antibodies were detected for the first time in Eurasian Lynx, Setland Pony, Fallow Deer, Ezo Sika, Formosa Deer, East Wapitis, Barasingha, Corriedale, American Bison, Guanacos, Reticulated Giraffe, and Saanen. These results indicate that the several zoo animal species were exposed to HEV.
Animals ; Animals, Zoo ; Antibodies ; Bison ; Camelids, New World ; Deer ; Hepatitis ; Hepatitis E ; Hepatitis E virus ; Humans ; Korea ; Lynx ; Seroepidemiologic Studies ; Taiwan

PURPOSE: In spite of an extensive vaccination program, parvoviral infections still pose a major threat to the health of dogs. MATERIALS AND METHODS: We isolated a novel canine parvovirus (CPV) strain from a dog with enteritis. Nucleotide and amino acid sequence analysis of the isolate showed that it is a novel type 2b CPV with asparagine at the 426th position and valine at the 555th position in VP2. To develop a vaccine against CPV infection, we passaged the isolate 4 times in A72 cells. RESULTS: The attenuated isolate conferred complete protection against lethal homologous CPV infection in dogs such that they did not develop any clinical symptoms, and their antibody titers against CPV were significantly high at 7-11 days post infection. CONCLUSION: These results suggest that the virus isolate obtained after passaging can be developed as a novel vaccine against paroviral infection.
Animals ; Asparagine ; Dogs ; Enteritis ; Parvovirus, Canine ; Sequence Analysis, Protein ; Sprains and Strains ; Vaccination ; Vaccines ; Valine ; Viruses

Monoclonal antibodies (mAbs) specific for the abnormal prion protein isoform (PrPres) are indispensable for diagnosing chronic wasting disease (CWD). In this study, eight mAbs were developed by immunizing PrP knockout mice with recombinant elk PrP and an immunogenic PrP peptide. The reactivity of the mAbs to recombinant PrP and the PrP peptide was measured, and their isotypes were subsequently determined. Among them, four mAbs (B85-05, B85-08, B85-12, and B77-75) were shown by Western blotting to recognize proteinase K-treated brain homogenate derived from an elk suffering from CWD.
Animals ; Antibodies, Monoclonal ; Blotting, Western ; Brain ; Mice ; Mice, Knockout ; Stress, Psychological ; Wasting Disease, Chronic