Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) syndrome is characterized by an altered mental status. The acute MRI lesions show abnormal restricted diffusion imaging bilaterally and symmetrically in the cerebellum, hippocampus, and basal nuclei. This syndrome is an unknown syndrome and is presumed to be mainly an opioidinduced toxidrome. Here, we present a case study wherein we show that it can also be caused by an antidepressant overdose.

Cardiovascular disease is the prime cause of morbidity and mortality and the population ages that may contribute to increase in the occurrence of cardiovascular disease. Arginase upregulation is associated with impaired endothelial function in aged vascular system and thus may contribute to cardiovascular disease. According to recent research, Korean Red Ginseng water extract (KRGE) may reduce cardiovascular disease risk by improving vascular system health. The purpose of this study was to examine mechanisms contributing to age-related vascular endothelial dysfunction and to determine whether KRGE improves these functions in aged mice. Young (10+/-3 weeks) and aged (55+/-5 weeks) male mice (C57BL/6J) were orally administered 0, 10, or 20 mg/mouse/day of KRGE for 4 weeks. Animals were sacrificed and the aortas were removed. Endothelial arginase activity, nitric oxide (NO) generation and reactive oxygen species (ROS) production, endothelial nitric oxide synthase (eNOS) coupling, vascular tension, and plasma peroxynitrite production were measured. KRGE attenuated arginase activity, restored nitric oxide (NO) generation, reduced ROS production, and enhanced eNOS coupling in aged mice. KRGE also improved vascular tension in aged vessels, as indicated by increased acetylcholine-induced vasorelaxation and improved phenylephrine-stimulated vasoconstriction. Furthermore, KRGE prevented plasma peroxynitrite formation in aged mice, indicating reduced lipid peroxidation. These results suggest KRGE exerts vasoprotective effects by inhibiting arginase activity and augmenting NO signaling and may be a useful treatment for age-dependent vascular diseases.
Aging ; Animals ; Aorta ; Arginase* ; Cardiovascular Diseases ; Humans ; Lipid Peroxidation ; Male ; Mice* ; Mortality ; Nitric Oxide ; Nitric Oxide Synthase Type III ; Panax* ; Peroxynitrous Acid ; Plasma ; Reactive Oxygen Species ; Up-Regulation ; Vascular Diseases ; Vasoconstriction ; Vasodilation ; Water*

OBJECTIVE: The purposes of this study were to analyze the current status of nursing informatics course and to develop the standardized curriculum in nursing informatics course based on competency. METHODS: Data were collected through two phases. In the first phase, a survey was conducted on 115 nursing institutions to analyze the current status of nursing informatics course. In the second phase, two-round delphi technique was developed to determine the priority and relative weight of contents in nursing informatics course. Final samples composed of both 43 nursing institutions and 11 nursing informatics experts. RESULTS: Out of 43 nursing schools, 13 nursing schools offered nursing informatics course. Nursing informatics was taught mostly to the second year and had 2 credits. About 54% of respondents disagreed that nursing informatics should be included in the license examination for Registered Nurse. The subject matrix by priority and relative weight and a standardized curriculum for nursing informatics were developed. CONCLUSION: Continuous application and revision of nursing informatics curriculum should be needed.
Competency-Based Education ; Curriculum* ; Surveys and Questionnaires ; Delphi Technique ; Licensure ; Nursing Informatics* ; Nursing* ; Schools, Nursing

A 73 year-old man was admitted to our hospital because of septic shock. He had undergone drug eluting stent (DES) insertion 40 days before this admission. After about 50 days in the hospital, a coccyx sore required a flap operation. The anticoagulation therapy (aspirin and clopidogrel) was then changed to LMWH. Eleven days after this change, he developed very severe chest pain. The emergency coronary angiography showed occlusion of the left anterior descending artery, left circumflex artery, and right coronary artery due to thrombosis. During the angiography procedure, his heart collapsed. We performed cardio-pulmonary resuscitation (CPR), but were unsuccessful. Patients in very high risk groups need special attention during peri-operative periods. Doctors must have full knowledge about the different anticoagulation strategies, and cooperation among the different clinical departments is needed to properly treat these high risk patients.
Angiography ; Arteries ; Cardiopulmonary Resuscitation ; Chest Pain ; Coccyx ; Coronary Angiography ; Coronary Vessels ; Emergencies ; Heart ; Heparin, Low-Molecular-Weight ; Humans ; Percutaneous Coronary Intervention ; Shock, Septic ; Stents ; Thrombosis

Orphan nuclear receptor estrogen-related receptor γ (ERRγ) regulates cell growth and tumorigenesis in various cancers. However, the clinical relevance of ERRγ to hepatocellular carcinoma (HCC) remains unclear. Here we examined the clinical significance of ERRγ in HCC and its potential as a therapeutic target. ERRγ levels in tissues from completely resected specimens from 190 HCC patients were examined immunohistochemically and their association with clinical stage and pathological grade was analyzed. Small interfering RNA (siRNA)-mediated knockdown of ERRγ (siRNA-ERRγ) or an ERRγ inverse agonist, GSK5182, were also used to examine the effects of ERRγ inhibition on the proliferation and growth of a human hepatoma cell line, PLC/PRF/5. Immunohistochemical analysis revealed that tumor tissues showed higher levels of ERRγ-positivity than adjacent non-tumor lesions. Tumors showing high levels of ERRγ immunoreactivity also had advanced tumor node metastasis (TNM) and Barcelona Clinic Liver Cancer stages and a higher Edmondson–Steiner grade. In addition, high-level expression of ERRγ in tumors of advanced TNM stage correlated with poorer overall survival. Treatment of PLC/PRF/5 cells with siRNA-ERRγ or GSK5182 inhibited proliferation through G1 arrest, increased expression of p21 and p27 and decreased expression of phosphorylated retinoblastoma protein. GSK5182-induced reactive oxygen species also suppressed the proliferation of PLC/PRF/5 cells. The present study showed that ERRγ expression is clinically significant in HCC; therefore, it can be considered a biomarker for HCC diagnosis. Moreover, the results provide a rationale for the use of ERRγ inhibitors such as GSK5182 as potential therapeutic agents.
Carcinogenesis ; Carcinoma, Hepatocellular ; Cell Line ; Cell Proliferation* ; Child ; Child, Orphaned ; Diagnosis ; Humans ; Liver Neoplasms* ; Liver* ; Neoplasm Metastasis ; Reactive Oxygen Species ; Retinoblastoma Protein ; RNA, Small Interfering

Most general anesthesia procedures are performed without any complications, but volatile agents may have adverse effects on various organ systems. Volatile anesthetic agents can cause mild to fulminant liver failure. However, while desflurane is a theoretical cause of hepatotoxicity, such cases have rarely been reported. We present here a 49-year-old man who developed hepatic dysfunction after laparoscopic cholecystectomy and this procedure was done under desflurane anesthesia.
Anesthesia ; Anesthesia, General ; Anesthetics ; Cholecystectomy, Laparoscopic ; Humans ; Isoflurane ; Liver ; Liver Failure, Acute ; Middle Aged

OBJECTIVE: To assess the learning curve of novice residents in diagnosing acute appendicitis using abdominal computed tomography (CT) scans. METHODS: This prospective observational study was conducted within a 4-month period from March 1 to June 30, 2015. After CT scans for right lower quadrant pain or similar acute abdomen were evaluated, postgraduate year 1 (PGY-1) residents completed an interpretation checklist. The primary outcome was evaluation of the learning curve for competent CT scan interpretation under suspicion of acute appendicitis. Secondary outcomes were cumulative numbers of accurate abdominal CT interpretations regardless of initial clinical impression and training period. RESULTS: PGY-1 residents recorded a total of 230 interpretation checklists. There were 53, 51, 46, 44, and 36 checklists recorded by individual residents and 92, 92, 91, 91, and 61 respective training days in the emergency department, excluding rotation periods in other departments. After 16 to 20 interpretations of abdominal CT scans performed under suspicion of acute appendicitis, the residents could diagnose acute appendicitis with more than 95% accuracy. Overall, the sensitivity and specificity for diagnosing acute appendicitis were 97% (95% confidence interval, 94 to 100) and 83% (95% confidence interval, 80 to 87), respectively. After 61 to 80 abdominal CT interpretations regardless of suspicion of acute appendicitis and after 41 to 50 days in training, PGY-1 emergency department residents could diagnose acute appendicitis with more than 95% accuracy. CONCLUSION: PGY-1 residents require 16 to 20 checklist interpretations to acquire acceptable abdominal CT interpretation. After performing 61 to 80 CT scans regardless of suspicion of acute appendicitis, they could diagnose acute appendicitis with acceptable accuracy.
Abdomen, Acute ; Appendicitis* ; Checklist ; Diagnosis* ; Emergency Service, Hospital ; Learning Curve* ; Learning* ; Observational Study* ; Prospective Studies* ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Background: Excessive proliferation and migration of vascular smooth muscle cells (VSMCs), which contributes to the development of occlusive vascular diseases, requires elevated mitochondrial oxidative phosphorylation to meet the increased requirements for energy and anabolic precursors. Therefore, therapeutic strategies based on blockade of mitochondrial oxidative phosphorylation are considered promising for treatment of occlusive vascular diseases. Here, we investigated whether DN200434, an orally available estrogen receptor-related gamma inverse agonist, inhibits proliferation and migration of VSMCs and neointima formation by suppressing mitochondrial oxidative phosphorylation. Methods: VSMCs were isolated from the thoracic aortas of 4-week-old Sprague-Dawley rats. Oxidative phosphorylation and the cell cycle were analyzed in fetal bovine serum (FBS)- or platelet-derived growth factor (PDGF)-stimulated VSMCs using a Seahorse XF-24 analyzer and flow cytometry, respectively. A model of neointimal hyperplasia was generated by ligating the left common carotid artery in male C57BL/6J mice. Results: DN200434 inhibited mitochondrial respiration and mammalian target of rapamycin complex 1 activity and consequently suppressed FBS- or PDGF-stimulated proliferation and migration of VSMCs and cell cycle progression. Furthermore, DN200434 reduced carotid artery ligation-induced neointima formation in mice. Conclusion Our data suggest that DN200434 is a therapeutic option to prevent the progression of atherosclerosis.

Occupational asthma is defined as a disease that is characterized by airway narrowing and bronchial hyperresponsiveness caused by specific working environment. It is estimated that occupational asthma cases in Korea have been underreported. This study, using Korean Medical Insurance Data(KMID), examined the distribution of asthma patients' occupations and the frequency of high risk occupations for occupational asthma in Seoul, Korea to evaluate the usefulness of the KMID data as a database for active occupational asthma surveillance system. Six hundreds and forty two(30.7%) of 2093 patients who were finally chosen as a study population by using 1995-year KMID, were contacted by telephone. 296 persons(47.4%) of 642 patients replied that they were diagnosed as asthma. The occupations of 296 asthma patients were classified by Korean standardized industrial classfication (KSIC). The most common occupations included Wholesale and Retail trade(19.5%), Real estate, Renting and Business activities(14.9%), Construction(14.9%), Manufacturing(12.3%). Forty(13.5%) of 296 patients who could be classified by KSIC were working at high risk jobs for occupational asthma. KMID could be used as a useful data for occupational asthma surveillance system if the limitations of KMID, which is the accuracy of diagnosis, data accessibility, difficulty of following up study subjects, would be solved. The prevalence of occupational asthma could be estimated if the follow-up study diagnosing occupational asthma for asthma patients working in high risk jobs would be held.
Asthma ; Asthma, Occupational* ; Commerce ; Diagnosis ; Follow-Up Studies ; Humans ; Insurance ; Korea* ; Occupations ; Prevalence ; Seoul ; Telephone

BACKGROUND: The hypoglycemic drugs dipeptidyl peptidase-4 (DPP-4) inhibitors have proven protective effects on diabetic kidney disease, including renal fibrosis. Although NOD-like receptor protein 3 (NLRP3) inflammasome activation is known to play an important role in the progression of renal fibrosis, the impact of DPP-4 inhibition on NLRP3-mediated inflammation while ameliorating renal fibrosis has not been fully elucidated. Here, we report that the renoprotective effect of gemigliptin is associated with a reduction in NLRP3-mediated inflammation in a murine model of renal fibrosis.METHODS: We examined the effects of gemigliptin on renal tubulointerstitial fibrosis induced in mice by unilateral ureteral obstruction (UUO). Using immunohistochemical and Western blot analysis, we quantitated components of the NLRP3 inflammasome in kidneys with and without gemigliptin treatment, and in vitro in human kidney tubular epithelial human renal proximal tubule cells (HK-2) cells, we further analyzed the effect of gemigliptin on transforming growth factor-β (TGF-β)-stimulated production of profibrotic proteins.RESULTS: Immunohistological examination revealed that gemigliptin ameliorated UUO-induced tubular atrophy and renal fibrosis. Gemigliptin-treated kidneys showed a reduction in levels of NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), caspase-1, and interleukin-1β, which had all been markedly increased by UUO. In line with thein vivoresults, TGF-β markedly increased NLRP3 inflammasome markers, which were attenuated by gemigliptin treatment. Furthermore, gemigliptin treatment attenuated phosphorylated nuclear factor-κB levels, which had been increased in the UUO kidney as well as in TGF-β-treated cultured renal cells.CONCLUSION: The present study shows that activation of the NLRP3 inflammasome contributes to UUO-induced renal fibrosis and the renoprotective effect of gemigliptin is associated with attenuation of NLRP3 inflammasome activation.
Animals ; Atrophy ; Blotting, Western ; Diabetic Nephropathies ; Dipeptidyl-Peptidase IV Inhibitors ; Down-Regulation ; Fibrosis ; Humans ; Hypoglycemic Agents ; In Vitro Techniques ; Inflammasomes ; Inflammation ; Kidney ; Mice ; Ureteral Obstruction