OBJECTIVES: Despite the fact that delirium is a frequent neuropsychiatric disorder in cancer patients, there are, in Korea, no guidelines for the pharmacological treatment of such delirium. This systematic review evaluated the efficacy and safety of some pharmacological interventions and summarized the results. METHODS: We searched PubMed, Embase, CINAHL, the Cochrane Library, and the KMbase, targeting from January 1990 to October 2008, using key words. Moreover, we included systematic reviews, meta-analyses, and randomized controlled trial literature in the search. Then, we stratified the trials based on their evidence levels. RESULTS AND CONCLUSION: We identified 13 randomized, controlled studies and 2 case-control studies that met our inclusion criteria. These showed that haloperidol was the medication of choice to treat delirium. In addition, they revealed that atypical antipsychotics have not shown clear superiority with regard to effectiveness as compared to haloperidol. Neither donepezil nor rivastigmine were shown to be effective in preventing or treating delirium.
Antipsychotic Agents ; Case-Control Studies ; Delirium ; Haloperidol ; Humans ; Indans ; Korea ; Phenylcarbamates ; Piperidines ; Rivastigmine

Background:Ghrelin is a new endogenous ligand for the growth hormone secretagogue receptor. It activates the release of growth hormone from the pituitary and it also participates in the regualtion of energy homeostasis. The aims of the study were to characterize the changes in plasma ghrelin levels in obese subjects compared with lean control or overweight subjects, and their relationship to various parameters in obese subjects. METHODS:In this study, 121 elementary school children were divided into 3 groups according to their body mass index (BMI). The lean control subjects consisted of 28 children who had less than 85 percentile of BMI. The overweight subjects consisted of 22 children who had 85-95 percentile of BMI. The obese subjects consisted of 71 children who had over 95 percentile of BMI. All subjects in 3 groups were evaluated according to their age, height, weight, obesity index, plasma ghrelin, serum lipid, glucose and insulin levels. Leu72Met mutation of prepro-ghrelin gene was directly detected by digesting the PCR fragments with Bsrl. RESULTS:Among antropometric data, body weight, BMI and obesity index were higher in obesity and overweight subjects than those of lean control subjects (P<0.05). The plasma ghrelin levels were significantly lower in overweight and obese subjects (P<0.05). In addition, serum triglyceride and LDL cholesterol levels were significantly higher in these groups compared to the control subjects (P<0.05). The concentrations of plasma ghrelin were significantly negatively correlated with BMI, obesity index, serum triglyceride, LDL cholesterol and insulin in all the children. However, there was no significant relationship between plasma ghrelin levels and any various parameters in obese subjects. Leu72Met mutation was detected in about 30% of obese children. However, we could not find any differences between lean control and obese children. CONCLUSION: We proved a significantly lower plasma ghrelin levels in overweight and obese subjects. Further studies are now needed to establish the role of ghrelin in the pathogenesis of human obesity.
Body Mass Index ; Body Weight ; Child* ; Cholesterol, LDL ; Ghrelin* ; Glucose ; Growth Hormone ; Homeostasis ; Humans ; Insulin ; Obesity* ; Overweight ; Plasma* ; Polymerase Chain Reaction ; Receptors, Ghrelin ; Triglycerides

PURPOSE: Insulin-like growth factor binding protein (IGFBP-3) and phosphatase and tensin homolog (PTEN) are tumor-suppressor genes that may be involved in breast tumorigenesis. However, the roles of these genes in the regulation of breast cancer growth or progress are unclear. In this study, we aimed to find any correlation between the reduction of IGFBP-3 or PTEN protein expression in cancer tissues and the clinicopathological parameters in breast cancer. METHODS: We collected both cancer and adjacent normal tissues from 46 breast cancer patients (from January 1 to December 31, 2006), and checked the IGFBP-3 and PTEN protein levels in cancer and adjacent normal tissues using Western immunoblot. We evaluated the correlation of reduction status of IGFBP-3 and PTEN protein expression with variable clinicopathological parameters. RESULTS: The frequency of IGFBP-3 and PTEN protein reduction in cancer tissue, compared to adjacent normal tissue, was 63.0% and 34.8%, respectively. And in 87.5% of patients, who showed significant PTEN reduction, IGFBP-3 protein expression was reduced in cancer tissues. In contrast, IGFBP-3 protein reduced in only 50% of patients who didn't show PTEN reduction. However, we did not find any significant correlation between reduction of IGFBP-3 or PTEN expression in cancer tissue and variable clinicopathological parameters. CONCLUSION: The IGFBP-3 and PTEN genes were expressed in all breast cancer tissues. Nonetheless, we did not find any significant relationship between reduction of IGFBP-3 or PTEN expression and the clinicopathological parameters in this study. Therefore, further studies are needed to document the roles of IGFBP-3 and PTEN genes in breast cancer growth or progress.
Blotting, Western ; Breast ; Breast Neoplasms ; Carrier Proteins ; Cell Transformation, Neoplastic ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Microfilament Proteins ; PTEN Phosphohydrolase

PURPOSE: Connective tissue reattachment to periodontally damaged root surfaces is one of the most important goals of periodontal therapy. The aim of this study was to develop a root conditioning agent that can demineralize and detoxify the infected root surface. METHODS: Dentin slices obtained from human teeth were treated with a novel root planing agent for 2 minutes and then washed with phosphate-buffered saline. Smear layer removal and type I collagen exposure were observed by scanning electron microscopy (SEM) and type I collagen immunostaining, respectively. Cell attachment and lipopolysaccharides (LPS) removal demonstrated the efficiency of the root conditioning agent. RESULTS: SEM revealed that the smear layer was entirely removed and the dentinal tubules were opened by the experimental gel. Type I collagen was exposed on the surfaces of the dentin slices treated by the experimental gel, which were compared with dentin treated with other root planing agents. Dentin slices treated with the experimental gel showed the highest number of attached fibroblasts and flattened cell morphology. The agar diffusion assay demonstrated that the experimental gel also has effective antimicrobial activity. Escherichia coli LPS were effectively removed from well plates by the experimental gel. CONCLUSIONS: These results demonstrated that this experimental gel is a useful tool for root conditioning of infected root surfaces and can also be applied for detoxification of ailing implant surface threads.
Agar ; Collagen ; Collagen Type I ; Connective Tissue ; Dentin ; Diffusion ; Drugs, Chinese Herbal ; Escherichia coli ; Fibroblasts ; Humans ; Lipopolysaccharides ; Microscopy, Electron, Scanning ; Root Planing ; Smear Layer ; Tooth

PURPOSE: To evaluate the effectiveness of transcatheter arterial chemoembolization(TACE) as a preoperative treatment for initially unresectable hepatoblastomas. METHODS: From January 1995 to July 1999, we identified two boys and three girls(age range: 5- 27 months; mean age: 12 months) with pathologically-confirmed hepatoblastoma. To assess response to treatment, we utilized an identical TACE procedure for all the patients. A second TACE procedure was performed 3 weeks after the first TACE procedure and patients underwent tumor resection approximately 1 month following the second TACE procedure. The therapeutic responses to TACE were assessed by measuring of tumor size, shape, observation of tumor properties using abdominal computed tomography(CT), gross and microscopic pathologic findings, levels of alpha- feto protein(AFP) and clinical adverse events to TACE. RESULTS: In these patients, hepatoblastomas showed marked reductions in tumor size. Massive tumor necrosis and homogeneous distribution of lipiodol created a clear margin bordered by surrounding normal liver tissue. At initial diagnosis, the mean AFP leve1=867Ang/mL, 47.4ng/mL after second TACE, and 8.6ng/mL at 6 months after surgical resection. Transient fever was ob- served following TACE and elevations of levels of AST and ALT were observed but these normalized 2 weeks following TACE. No major complications were associated with TACE. CONCLUSION: We suggest that preoperative TACE is an effective, safe, and useful method for patients with initially unresectable hepatoblastoma.
Diagnosis ; Ethiodized Oil ; Fever ; Hepatoblastoma* ; Humans ; Liver ; Necrosis

PURPOSE: The aim of this study is to determine whether certain biomaterials have the potential to support cell attachment. After seeding bone marrow stromal cells onto the biomaterials, we investigated their responses to each material in vitro. METHODS: Rat bone marrow derived stromal cells were used. The biomaterials were deproteinized bovine bone mineral (DBBM), DBBM coated with fibronectin (FN), synthetic hydroxyapatite (HA), HA coated with FN, HA coated with beta-tricalcium phosphate (TCP), and pure beta-TCP. With confocal laser scanning microscopy, actin filaments and vinculin were observed after 6, 12, and 24 hours of cell seeding. The morphological features of cells on each biomaterial were observed using scanning electron microscopy at day 1 and 7. RESULTS: The cells on HA/FN and HA spread widely and showed better defined actin cytoskeletons than those on the other biomaterials. At the initial phase, FN seemed to have a favorable effect on cell adhesion. In DBBM, very few cells adhered to the surface. CONCLUSIONS: Within the limitations of this study, we can conclude that in contrast with DBBM not supporting cell attachment, HA provided a more favorable environment with respect to cell attachment.
Actin Cytoskeleton ; Animals ; Biocompatible Materials ; Bone Marrow ; Bone Substitutes ; Calcium Phosphates ; Cell Adhesion ; Durapatite ; Fibronectins ; Mesenchymal Stromal Cells ; Microscopy, Confocal ; Microscopy, Electron, Scanning ; Rats ; Seeds ; Stem Cells ; Stromal Cells ; Transplants ; Vinculin

The purpose of this study was to evaluate newly fabricated tricalcium phosphate(TCP)/chitosan microgranuls as bone substitutes. TCP/chitosan microgranules were fabricated by dropping TCP-chitosan suspension into the NaOH/ethanol solution. The size of microgranules could be controllable via airflow rate. PDGF-BB was loaded into the fabricated granules via freeze-drying methods(300 ng/20 mg). To evaluate cell proliferation, cultured osteoblasts cell lines(MC3T3-E1) was dropped on the BioOss(R), chitosan microgranules, TCP/chitosan microgranules and cultured for 1, 7, 14, and 28 days. Scanning electron microscopic observation was done after 7 days of culture and light microscopic examination was done after 28 days of culture. PDGF-BB release from the microgranules was tested. Rabbit calvarial defects(8 mm in diameter) were formed and chitosan, TCP/chitosan, PDGF-TCP/chitosan microgranules, and BioGran(R) were grafted to test the ability of new bone formation. At SEM view, the size of prepared microgranules was 250-1000 um and TCP powders were observed at the surface of TCP/chitosan microgranules. TCP powders gave roughness to the granules and this might help the attachment of osteoblasts. The pores formed between microgranules might be able to allow new bone ingrowth and vascularization. There were no significant differences in cell number among BioOss(R) and two microgranules at 28 day. Light and scanning electron microscopic examination showed that seeded osteoblastic cells were well attached to TCP/chitosan microgranules and proliferated in a multi-layer. PDGF-BB released from TCP/chitosan microgranules was at therapeutic concentration for at least 1 week. In rabbit calvarial defect models, PDGF-TCP/chitosan microgranules grafted sites showed thicker bone trabeculae pattern and faster bone maturation than others. These results suggested that the TCP/chitosan microgranules showed the potential as bone substitutes.
Bone Substitutes ; Cell Count ; Cell Proliferation ; Chitosan* ; Osteoblasts ; Osteogenesis* ; Powders ; Transplants

The aim of this study is to monitor reporter gene expression under osteocalcin gene promoter, using a real-time molecular imaging system, as tool to investigate osteoblast differentiation. The promoter region of mouse osteocalcin gene 2 (mOG2), the best-characterized osteoblast- specific gene, was inserted in promoterless luciferase reporter vector. Expression of reporter gene was confirmed and relationship between the reporter gene expression and osteoblastic differentiation was evaluated. Gene expression according to osteoblstic differentiation on biomaterials, utilizing a real-time molecular imaging system, was monitored. Luciferase was expressed at the only cells transduced with pGL4/mOGP and the level of expression was statistically higher at cells cultured in mineralization medium than cells in growth medium. CCCD camera detected the luciferase expression and was visible differentiation-dependent intensity of luminescence. The cells produced osteocalcin with time-dependent increment in BMP-2 treated cells and there was difference between BMP-2 treated cells and untreated cells at 14days. There was difference at the level of luciferase expression under pGL4/mOGP between BMP-2 treated cells and untreated cells at 3days. CCCD camera detected the luciferase expression at cells transduced with pGL4/mOGP on Ti disc and was visible differentiation-dependent intensity of luminescence This study shows that 1) expression of luciferase is regulated by the mouse OC promoter, 2) the CCCD d etection s ys tem is a r eliable quantitative gene d etection t ool f or t he o s teoblas t differentiation, 3) the dynamics of mouse OC promoter regulation during osteoblast differentiation is achieved in real time and quantitatively on biomaterial. The present system is a very reliable system for monitoring of osteoblast differentiation in real time and may be used for monitoring the effects of growth factors, drug, cytokines and biomaterials on osteoblast differentiation in animal.
Animals ; Biocompatible Materials ; Cytokines ; Gene Expression ; Genes, Reporter ; Intercellular Signaling Peptides and Proteins ; Luciferases* ; Luminescence ; Mice ; Molecular Imaging ; Osteoblasts* ; Osteocalcin* ; Promoter Regions, Genetic

The purpose of this study is to evaluate the effects of bioresorbable membranes in guided bone regeneration of streptozotocin induced diabetic rats. 50 Sprague-Dawley rats were randomly categorized into 4 groups: Group 1 & 2 had 10 normal rats each and group 3 & 4 included 15 streptozotocin induced diabetic rats each. Defect measuring 7mm in diameter was formed on every rat calvarium. No membrane was used in groups 1 & 3 and membranes were used in groups 2 & 4. The rates were sacrificed at 2 and 4 weeks after defect formation. Routine histological specimens were prepared. Masson-trichrome and HE stain were done before light microscopy. Guided regenerative potential was evaluated by measuring the amount of new bone formation in the calvarial defect by histomorphometry. Following results were obtained. 1.New bone formation in the diabetic groups was significantly less that than in the normal groups regardless of membrane use(p <0.05). 2.In the comparison of new bone formation in the normal groups, membrane group showed significantly more bone formation(p <0.1). 3.When the amount of new bone formation was compared in the diabetic groups, more bone was formed in the membrane groups but the difference was not statistically significant. 4.In the normal groups the amount of new bone formation was significantly greater at 4 weeks compared to that at 2 weeks(p <0.05) but amount of bone regeneration at 4 weeks was not significantly greater than that at 2 weeks in both diabetic groups.
Animals ; Bone Regeneration* ; Diabetes Mellitus ; Membranes* ; Microscopy ; Osteogenesis ; Rats* ; Rats, Sprague-Dawley ; Skull ; Streptozocin*

PURPOSE: Fibronectin(FN), one of the major components of ECM, mediates wide variety of cellular interactions including cell adhesion, migration, proliferation and differentiation. In this study, we used synthetic peptides based on fibrin binding sites of amino-terminal of FN and evaluated their biologic effects on periodontal ligament(PDL) cells. MATERIALS AND METHODS: PDL cells were cultured on synthetic oligopeptides coated dishes and examined for cell adhesion, proliferation via confocal microscope. For detection of ERK1/2, cells were plated and Western blot analysis was performed. RESULTS: PDL cells on synthetic oligopeptide coated dishes showed enhanced cell adhesion and proliferation. Western blot analysis revealed increased level of ERK1/2 phosphorylation in cells plated on FN fragment containing fibrin-binding domain(FF1 and FF5) coated dishes. CONCLUSION: These results reveals that FN fragment containing fibrin-binding domain possess an enhanced biologic effect of PDL ligament cells.
Binding Sites ; Blotting, Western ; Cell Adhesion ; Fibrin ; Fibronectins ; Ligaments ; Oligopeptides ; Peptides ; Periodontal Ligament ; Phosphorylation