Here we report a case of serotonin syndrome caused by fluoxetine 20 mg and duloxetine 60 mg independently eight week apart. A 65-year old man developed fever, agitation and change of mental status after two weeks treatment with 20 mg of fluoxetine for depressive disorder. He was diagnosed unknown fever origin and discharged when fever subsided as antidepressant stopped. Eight weeks later he was prescribed 60 mg of duloxetine for the treatment of depressed mood. After 18 days on duloxetine he developed fever, agitation, myoclonus and change in mental status again. He improved rapidly after discontinuation of offending drug with supportive care. Despite serotonin syndrome is usually caused by poly-pharmacy of serotonergic drugs, this case shows unusual serotonin syndrome developed by therapeutic dose of two drugs of different classes independently.
Depressive Disorder ; Dihydroergotamine ; Fever ; Fluoxetine ; Humans ; Myoclonus ; Serotonin ; Serotonin Agents ; Serotonin Syndrome ; Thiophenes ; Duloxetine Hydrochloride

BACKGROUND: An outbreak of measles was reported again in 2000 nationwide. For that reason, research was done to evaluate the necessity of relevant re-vaccination and efficacy of primary vaccination of MMR when measles was prevalent, by way of comparative study for serological test results of the patients hospitalized at SAMSUN HOSPITAL in Busan in 2000. METHODS: From Jan to Dec 2000, we reviewed 108 cases with medical history confirmed as measles by clinical and serological examination and checked whether inoculation of primary vaccination of MMR was done or not and the date of vaccination through telephone survey, separated. The study subjects were into two groups, vaccinated, and unvaccinated, and antibody of measles were checked according to sex, season, and age. RESULTS: It was observed that a great number of people caught measles in May-June comprising 56 case (58.3%) among 108 cases analyzed and the wide range of an attack of measles was under two years of age with 37 cases (34.3%) under one year of age and 33 cases (30.6%) between 1-2 year old. CONCLUSION: According to the results of serum diagnosis of the measles case study, vaccination for measles is needed at the age of 6 month to one year because all those under one year of age who had not received a vaccine contacted the disease. The importance of booster was raised for those above 3 years old because those who had prior vaccination against measles contacted the disease.
Busan ; Child, Preschool ; Diagnosis ; Humans ; Measles* ; Seasons ; Serologic Tests ; Telephone ; Vaccination

PURPOSE: To evaluate the diagnostic usefulness of brachial approach arteriography for outpatients, withparticular regard to safety and image quality. MATERIALS AND METHODS: The angiographic findings and follow-upmedical records of 131 brachial approach arteriographies in 121 outpatients were retrospectively analysed. 5 Fpigtail catheters were used in 125 cases, and 5-F OCU-A catheters were used in three cases of renal arteriography,and three of upper extremity arteriography without catheter. RESULTS: Except for three cases of brachial arterypuncture failure, all procedures were performed successfully. One hundred and fifteen of 119 lower extremityarteriographies were visualized down to the level of the tibioperoneal artery. The non-visualized cases were threein which there was multiple obstruction at the distal common iliac artery and one with insufficient contrastamount due to renal failure. In four cases there were complications : two involved arterial thrombosis, one was anintramuscular hematoma, and one an A-V fistula. CONCLUSION: For outpatients, brachial approach arteriography canreplace the femoral approach. Its image quality is excellent, there are time-cost benefits, and the rate ofcomplications is relatively low.
Angiography* ; Arteries ; Brachial Artery* ; Catheters ; Fistula ; Hematoma ; Humans ; Iliac Artery ; Outpatients* ; Renal Insufficiency ; Retrospective Studies ; Thrombosis ; Upper Extremity

Using normal canine embryonic fibroblasts (CaEF) that were shown to be senescent at passages 7th-9th, we established two spontaneously immortalized CaEF cell lines (designated CGFR-Ca-1 and -2) from normal senescent CaEF cells, and an immortal CaEF cell line by exogenous introduction of a catalytic telomerase subunit (designated CGFR-Ca-3). Immortal CGFR- Ca-1, -2 and -3 cell lines grew faster than primary CaEF counterpart in the presence of either 0.1% or 10% FBS. Cell cycle analysis demonstrated that all three immortal CaEF cell lines contained a significantly high proportion of S-phase cells compared to primary CaEF cells. CGFR-Ca-1 and -3 cell lines showed a loss of p53 mRNA and protein expression leading to inactivation of p53 regulatory function, while the CGFR-Ca-2 cell line was found to have the inactive mutant p53. Unlike the CGFR-Ca-3 cell line that down-regulated p16INK4a mRNA due to its promoter methylation but had an intact p16INK4a regulatory function, CGFR-Ca-1 and -2 cell lines expressed p16INK4a mRNA but had a functionally inactive p16INK4a regulatory pathway as judged by the lack of obvious differences in cell growth and phenotype when reconstituted with wild-type p16INK4a. All CGFR-Ca-1, -2 and -3 cell lines were shown to be untransformed but immortal as determined by anchorage-dependent assay, while these cell lines were fully transformed when overexpressed oncogenic H-rasG12V. Taken together, similar to the nature of murine embryo fibroblasts, the present study suggests that normal primary CaEF cells have relatively short in vitro lifespans and should be spontaneously immortalized at high frequency.
Animals ; Catalytic Domain/genetics ; *Cell Aging/genetics ; Cell Line, Transformed ; Cell Transformation, Neoplastic ; Dogs ; Embryo/cytology ; Fibroblasts/*cytology/metabolism ; Gene Expression ; Protein p16/genetics ; Protein p53/genetics ; RNA, Messenger/analysis/metabolism ; Research Support, Non-U.S. Gov't ; Telomerase/genetics/metabolism ; ras Proteins/genetics/metabolism

OBJECTIVE: Living donor liver transplantation is a surgical treatment which could impose a heavy burden on both the recipient and the potential donor. Preoperative psychological evaluation of the potential donor is essential in protecting one's psychosocial well-being, as well as one's autonomy. In this research, we examined the correlation between the preoperative psychological profile of the potential donor and one's postoperative pain and opioid analgesic usage. METHODS: Retrospective review of the medical records of all living donors who had completed preoperative psychological evaluation in our transplantation center from January, 2010 to December, 2011 was done. Preoperative psychological evaluation included Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Sentence Complete Test and an interview with a psychiatrist. Mean postoperative pain within 7 days after the surgery was evaluated. Dosages of all opioid analgesics were converted to equivalent dosage of morphine. RESULTS: Depression T-score showed a significant correlation with the duration of opioid analgesics usage (R2=0.306, F=12.363). Also, F score and dosage of opioid analgesics (R2=0.360, F=15.766), as well as Psychasthenia T- score and postoperative mean pain score (R2=0.137, F=4.448) showed significant correlation. CONCLUSION: Depression T-score, F score and Psychastenia T-score from MMPI-2 are well known to reflect one's depression, discontent, psychological instability and chronic anxiety. Such personalized and specified psychiatric intervention could help the donor to cope with post-surgical pain better.
Analgesics, Opioid ; Anxiety ; Depression ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Medical Records ; Minnesota ; MMPI ; Pain, Postoperative ; Phosphatidylethanolamines ; Psychiatry ; Retrospective Studies ; Tissue Donors ; Transplants

BACKGROUND: Many reports suggest that cervical sympathectomy improves cerebral blood flow. But the basal & medial areas of brain are innervated bilaterally, so unilateral sympathectomy may not improve the outcome of infarction of those areas effectively. Actually it was reported that only bilateral, not unilateral cervical sympathectomy increased the blood flow of thalamus which known to be innervated bilaterally, and also reported that unilateral sympathectomy did not reduce the infarct size of caudate nucleus. So we studied the effect of bilateral superior cervical sympathectomy on focal cerebral infarction. METHODS: Twenty rabbits were divided into two groups. In the sham-operated control group (n=10), focal infarction was achieved by administering an autologous blood clot into the internal carotid artery after exposure of bilateral superior cervical sympathetic ganglia. In the sympathectomy group (n=10), bilateral superior cervical sympathetic ganglia were excised following embolization. Seven hours after embolization, brains were sliced into 2 mm coronal sections, stained with 2,3,5-triphenyltetrazolium chloride, and infarct sizes were determined via image analysis. RESULTS: There were no differences in the physiologic variables between two groups. The percentage of infarct size was significantly greater in the control group as compared to the sympathectomy group in both cortex (23+/-8% vs 12+/-5%, respectively; P<0.05) and subcortical area (35+/-8% vs 17+/-8%, respectively; P<0.05). CONCLUSIONS: These results suggest that bilateral superior cervical sympathectomy may reduce the infarct size of subcortical area as well as of cerebral cortex measured at 7 hours following induction of focal cerebral infarction.
Brain ; Carotid Artery, Internal ; Caudate Nucleus ; Cerebral Cortex ; Cerebral Infarction* ; Ganglia, Sympathetic ; Infarction ; Rabbits* ; Sympathectomy* ; Thalamus

Objective: The impact of the government-initiated senior employment program (GSEP) on geriatric depressive symptoms is underexplored. Unearthing this connection could facilitate the planning of future senior employment programs and geriatric depression interventions. In the present study, we aimed to elucidate the possible association between geriatric depressive symptoms and GSEP in older adults. Methods: This study employed data from 9,287 participants aged 65 or older, obtained from the 2020 Living Profiles of Older People Survey. We measured depressive symptoms using the Korean version of the 15-item Geriatric Depression Scale. The principal exposure of interest was employment status and GSEP involvement. Data analysis involved multiple linear regression. Results: Employment, independent of income level, showed association with decreased depressive symptoms compared to unemployment (p<0.001). After adjustments for confounding variables, participation in GSEP jobs showed more significant reduction in depressive symptoms than non-GSEP jobs (β=-0.968, 95% confidence interval [CI]=-1.197 to -0.739, p<0.001 for GSEP jobs, β=-0.541, 95% CI=-0.681 to -0.401, p<0.001 for non-GSEP jobs). Notably, the lower income tertile in GSEP jobs showed a substantial reduction in depressive symptoms compared to all income tertiles in non-GSEP jobs. Conclusion The lower-income GSEP group experienced lower depressive symptoms and life dissatisfaction compared to non-GSEP groups regardless of income. These findings may provide essential insights for the implementation of government policies and community-based interventions.

The objective of this study was to compare the efficacy of cardiopulmonary resuscitation (CPR) with 120 compressions per minute (CPM) to CPR with 100 CPM in patients with non-traumatic out-of-hospital cardiac arrest. We randomly assigned patients with non-traumatic out-of-hospital cardiac arrest into two groups upon arrival to the emergency department (ED). The patients received manual CPR either with 100 CPM (CPR-100 group) or 120 CPM (CPR-120 group). The primary outcome measure was sustained restoration of spontaneous circulation (ROSC). The secondary outcome measures were survival discharge from the hospital, one-month survival, and one-month survival with good functional status. Of 470 patients with cardiac arrest, 136 patients in the CPR-100 group and 156 patients in the CPR-120 group were included in the final analysis. A total of 69 patients (50.7%) in the CPR-100 group and 67 patients (42.9%) in the CPR-120 group had ROSC (absolute difference, 7.8% points; 95% confidence interval [CI], -3.7 to 19.2%; P = 0.183). The rates of survival discharge from the hospital, one-month survival, and one-month survival with good functional status were not different between the two groups (16.9% vs. 12.8%, P = 0.325; 12.5% vs. 6.4%, P = 0.073; 5.9% vs. 2.6%, P = 0.154, respectively). We did not find differences in the resuscitation outcomes between those who received CPR with 100 CPM and those with 120 CPM. However, a large trial is warranted, with adequate power to confirm a statistically non-significant trend toward superiority of CPR with 100 CPM. (Clinical Trial Registration Information: www.cris.nih.go.kr, cris.nih.go.kr number, KCT0000231)
Cardiopulmonary Resuscitation* ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Out-of-Hospital Cardiac Arrest ; Outcome Assessment (Health Care) ; Resuscitation

OBJECTIVE: Human papillomavirus (HPV) has been identified in the majority of invasive cervical cancer patient and has been found to contribute in a significant way to the genesis of human cervical cancer. HPV has two transforming genes that encode the oncoproteins E6 and E7, E6 can form complexes with p53 and promote p53 degradation, E7 inhibit retinoblastoma protein (RB). The p53 protein is as a phosphoprotein which co-immunoprecipitated with the SV40 T-Antigen. The wild type p53 protein is capable of suppressing the tumorigenic phenotype and regulating cell cycle. Adeno-associated virus(AAV) is a linear single stranded DNA parvovirus which is dependent upon cotransfection by a second unrelated virus to undergo productive infection. It has been well documented that AAV DNA integrates into cellular DNA as one to several tandem copies joined to cellular DNA through the termini. In order to introduce wild type p53 through AAV virus into a cervical cancer patient for gene therapy, we had constructed recombinant p53 adeno associated virus plasmid (pAAVCMVp53). METHODS: pAAVCMVp53 was created new AAV-vector system, pRc/CMVp53 including p53 cDNA and AAV-derivative vector, pASPA-AAV-CMV-polyA were made to HindIII/blunt fragments. Eluated 1.8 kb fragment of wild type p53 cDNA was ligated to pAAV-CMV-polyA, 4.9 kb fragment deprived hASPA cDNA. RESULT: Recombinant AAVCMVp53 was constructed by using pRc/CMVp53 andpASPA-AAV-CMV-polyA. This pAAVCMVp53 was confirmed by various restriction enzyme-digestions and Southern-blotting. This new vector system will be studied on expression, stability in cervical cancer cell lines and animals. CONCLUSION: This system will be one of the useful vector system for cervical cancer gene therapy.
Animals ; Antigens, Viral, Tumor ; Cell Cycle ; Cell Line ; Clone Cells ; DNA ; DNA, Complementary ; DNA, Single-Stranded ; Genetic Therapy* ; Humans ; Oncogene Proteins ; Oncogenes ; Parvovirus ; Phenotype ; Plasmids ; Retinoblastoma Protein ; Satellite Viruses ; Uterine Cervical Neoplasms*

Recent evidence has suggested that human skin fibroblasts may represent a novel source of therapeutic stem cells. In this study, we report a 3-stage method to induce the differentiation of skin fibroblasts into insulin-producing cells (IPCs). In stage 1, we establish the isolation, expansion and characterization of mesenchymal stem cells from human labia minora dermis-derived fibroblasts (hLMDFs) (stage 1: MSC expansion). hLMDFs express the typical mesenchymal stem cell marker proteins and can differentiate into adipocytes, osteoblasts, chondrocytes or muscle cells. In stage 2, DMEM/F12 serum-free medium with ITS mix (insulin, transferrin, and selenite) is used to induce differentiation of hLMDFs into endoderm-like cells, as determined by the expression of the endoderm markers Sox17, Foxa2, and PDX1 (stage 2: mesenchymal-endoderm transition). In stage 3, cells in the mesenchymal-endoderm transition stage are treated with nicotinamide in order to further differentiate into self-assembled, 3-dimensional islet cell-like clusters that express multiple genes related to pancreatic beta-cell development and function (stage 3: IPC). We also found that the transplantation of IPCs can normalize blood glucose levels and rescue glucose homeostasis in streptozotocin-induced diabetic mice. These results indicate that hLMDFs have the capacity to differentiate into functionally competent IPCs and represent a potential cell-based treatment for diabetes mellitus.
Animals ; Biological Markers/metabolism ; *Cell Culture Techniques ; *Cell Differentiation ; Cell Proliferation/drug effects ; Cell Separation ; Cells, Cultured ; Dermis/*cytology/drug effects ; Diabetes Mellitus, Experimental/*surgery ; Female ; Fibroblasts/*cytology/drug effects ; Genitalia, Female/*cytology ; Glucose/metabolism ; Hepatocyte Nuclear Factor 3-beta/metabolism ; Homeodomain Proteins/metabolism ; Humans ; Insulin/pharmacology/secretion ; Insulin-Secreting Cells/*cytology/metabolism ; *Islets of Langerhans Transplantation ; Mesenchymal Stem Cells/*cytology/drug effects/metabolism ; Mice ; Mice, Nude ; Niacinamide/pharmacology ; Recovery of Function ; SOXF Transcription Factors/metabolism ; Sodium Selenite/pharmacology ; Trans-Activators/metabolism ; Transferrin/pharmacology