PURPOSE: We describe the changes of rat glomerular epithelial cells when exposed to high levels of glucose and advanced glycosylation endproducts(AGE) in the in vitro diabetic condition. We expect morphological alteration of glomerular epithelial cells and permeability changes experimentally and we may correlate the results with a mechanism of proteinuria in DM. METHODS: We made 0.2 M glucose-6-phsphate solution mixed with PBS(pH 7.4) containing 50 mg/mL BSA and protease inhibitor for preparation of AGE. As control, we used BSA. We manufactured and symbolized five culture dishes as follows; B5 - normal glucose(5 mM) + BSA, B30 - high glucose(30 mM) + BSA, A5 - normal glucose(5 mM) + AGE, A30 - high glucose(30 mM) + AGE, A/B 25 - normal glucose(5 mM) + 25 mM of mannitol(osmotic control). After the incubation period of both two days and seven days, we measured the amount of heparan sulfate proteoglycan(HSPG) in each dish by ELISA and compared them with the B5 dish at 2nd and 7th incubation days. We observed the morphological changes of epithelial cells in each culture dish using scanning electron microscopy(SEM). We tried the permeability assay of glomerular epithelial cells using cellulose semi-permeable membrane measuring the amount of filtered BSA through the apical chamber for 2 hours by sandwich ELISA. RESULTS: On the 2nd incubation day, there was no significant difference in the amount of HSPG between the 5 culture dishes. But on the 7th incubation day, the amount of HSPG increased by 10% compared with the B5 dish on the 2nd day except the A30 dish(P<0.05). Compared with the B5 dish on the 7th day the amount of HSPG in A30 and B30 dish decreased to 77.8% and 95.3% of baseline, respectively(P>0.05). In the osmotic control group (A/B 25) no significant correlation was observed. On the SEM, we could see the separated intercellular junction and fused microvilli of glomerular epithelial cells in the culture dishes where AGE was added. The permeability of BSA increased by 19% only in the A30 dish on the 7th day compared with B5 dish on the 7th day in the permeability assay(P<0.05). CONCLUSION: We observed not only the role of a high level of glucose and AGE in decreasing the production of HSPG of glomerular epithelial cells in vitro, but also their additive effect. However, the role of AGE is greater than that of glucose. These results seems to correlate with the defects in charge selective barrier. Morphological changes of the disruption of intercellular junction and fused microvilli of glomerular epithelial cells seem to correlate with the defects in size-selective barrier. Therefore, we can explain the increased permeability of glomerular epithelial units in the in vitro diabetic condition.
Animals ; Cellulose ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Glucose* ; Glycosylation* ; Heparan Sulfate Proteoglycans ; Heparitin Sulfate ; Intercellular Junctions ; Membranes ; Microvilli ; Permeability* ; Protease Inhibitors ; Proteinuria ; Rats

PURPOSE:This study was designed to clarify the mechanism of proteinuria in nephrotic syndrome patients by using puromycin aminonucleoside (PAN) nephrosis model. METHODS:Following administration of various concentrations of PAN and antioxidants we observed the changes of podocyte cytoskeletons in cultured rat glomerular epithelial cells (GEpC) by method of scanning electron microscope, reactive oxyten species (ROS) analysis, permeability assay, confocal microscope, and Western blot assay. RESULTS:PAN not only induced the ultrastructural changes of GEpC, such as shortening and fusion of microvilli, but also separated the intercellular gaps and linear ZO-1. PAN induced oxidative stresses in time and dose dependent manners and increases of intercellular permeability in anti-oxidants inhibitable manners. High concentration of PAN induced not only actin polymerization and disorganization, but also the conglomerulation and internal dislocation of alpha-actinin protein. The intensities of fluorescences of ZO-1 protein were diminished and internalized by PAN in a dose-dependent manner, which were inhibited by anti anti-oxidants. CONCLUSION:PAN induced the changes of podocytes cytoskeleton and junctional barriers by way of increasing ROS in GEpC that resulted in increasing their permeability in a antioxidatn-inhibitable manner. Glomerular hyperpermeability induced by PAN mediateing through oxidative stresses is thought to take part in the mechanism of proteinuria in nephrotic syndrome. (Korean J Pediatr 2008;51:54-61)
Actinin ; Actins ; Animals ; Antioxidants ; Ascorbic Acid ; Blotting, Western ; Cytoskeleton ; Dislocations ; Electrons ; Epithelial Cells ; Glycyrrhetinic Acid ; Humans ; Microvilli ; Nephrosis ; Nephrotic Syndrome ; Oxidative Stress ; Permeability ; Podocytes ; Polymerization ; Polymers ; Proteinuria ; Puromycin ; Puromycin Aminonucleoside ; Rats

The congenital long-QT syndrome (LQTS) is characterized by recurrent syncope, prolonged QT intervals, QT interval lability, polymorphic ventricular tachycardia, and sudden death. We report a case of congenital long QT syndrome in a 28-day-old male infant who presented with syncope, bradycardia with 2: 1 pseudo-atrioventricular block and a markedly prolonged QT inteval. One episode occured after crying and degenerated into ventricular fibrillation and terminated after cardioversion. A VVI type cardiac pacemaker was implanted. Subsequently, the infant's heart rate was over 110/min and 2: 1 AV block and any other arrhythmia were absent. The infant recovered from the accompanied pneumonia and sepsis and was discharged 47 days after adrnission. However, 13 days after discharge, the infant returned to our hospital ER with syncope. Ventricular fibrillation ceased after cardioversion. Despite medication with propranolol, ventricular tachycardia persisted. The infant expired the day after he was discharged against medical advice.
Arrhythmias, Cardiac ; Atrioventricular Block* ; Bradycardia ; Crying ; Death, Sudden ; Electric Countershock ; Heart Rate ; Hospitals ; Humans ; Infant ; Long QT Syndrome ; Male ; Pneumonia ; Propranolol ; Sepsis ; Syncope ; Tachycardia, Ventricular ; Ventricular Fibrillation

Anti-N-methyl D-aspartate receptor (anti-NMDAR) encephalitis, recently recognized as a form of paraneoplastic encephalitis, is characterized by a prodromal phase of unspecific illness with fever that resembles a viral disease. The prodromal phase is followed by seizures, disturbed consciousness, psychiatric features, prominent abnormal movements, and autonomic imbalance. Here, we report a case of anti-NMDAR encephalitis with initial symptoms of epilepsia partialis continua in the absence of tumor. Briefly, a 3-year-old girl was admitted to the hospital due to right-sided, complex partial seizures without preceding febrile illness. The seizures evolved into epilepsia partialis continua and were accompanied by epileptiform discharges from the left frontal area. Three weeks after admission, the patient's seizures were reduced with antiepileptic drugs; however, she developed sleep disturbances, cognitive decline, noticeable oro-lingual-facial dyskinesia, and choreoathetoid movements. Anti-NMDAR encephalitis was confirmed by positive detection of NMDAR antibodies in the patient's serum and cerebrospinal fluid, and her condition slowly improved with immunoglobulin, methylprednisolone, and rituximab. At present, the patient is no longer taking multiple antiepileptic or antihypertensive drugs. Moreover, the patient showed gradual improvement of motor and cognitive function. This case serves as an example that a diagnosis of anti-NMDAR encephalitis should be considered when children with uncontrolled seizures develop dyskinesias without evidence of malignant tumor. In these cases, aggressive immunotherapies are needed to improve the outcome of anti-NMDAR encephalitis.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis* ; Antibodies ; Anticonvulsants ; Antihypertensive Agents ; Cerebrospinal Fluid ; Child* ; Child, Preschool ; Cognition ; Consciousness ; D-Aspartic Acid ; Diagnosis ; Dyskinesias ; Encephalitis ; Epilepsia Partialis Continua* ; Female ; Fever ; Humans ; Immunoglobulins ; Immunotherapy ; Korea* ; Methylprednisolone ; Rituximab ; Seizures ; Virus Diseases

PURPOSE: The authors performed an autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack-Lichtman type II scaphoid waist nonunion. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment. METHODS: We retrospectively reviewed medical records and radiographs of 30 patients who underwent a cancellous bone graft and headless compression screw fixation for scaphoid waist nonunion. There 28 men and 2 women with a mean age of 32.8 year-old (range, 21–63 year-old). The mean time to surgery from initial injury was 10 months (range, 3–25 months) and the average follow-up duration was 37.5 months (range, 15–52 months). The authors analyzed bony union, lateral intrascaphoid angle (LISA), scapholunate angle (SLA), radiolunate angle (RLA), and scaphoid length in radiographs and evaluated the modified Mayo wrist score (MMWS) as a functional outcome. RESULTS: Bony union was achieved in all cases. In lateral plain X-ray, preoperative anatomic alignment including LISA, SLA, RLA, and scaphoid length was recovered at immediate postoperative measurement. Those alignment restoration was likely to maintain in final follow-up in despite of statistical difference. The wrist motion and the MMWS improved significantly at the last follow-up. CONCLUSION: A non-structural autologous cancellous bone graft from the iliac crest and headless screw fixation provided reliable results and can be one of the effective treatment options for patients with symptomatic Mack-Lichtman type II nonunion in the middle one-third of the scaphoid.
Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies ; Transplants* ; Wrist

BACKGROUND: Automated border detection(ABD) is a new echocardiographic modality providing continuous on-line measurements of left ventricular(LV) cavitary ares, volume, and ejection fraction(EF) throughout the cardiac cycle. Previous study showed that LV volume and EF measurements with ABD system approximate manually traced LV volume and EF obtained with conventional 2-dimensional echocardiography. But further clinical validation needs a comparison of LV function between the ABD system and established methods. The purpose of this study is to compare EF, peak ejection rate(PER) and peak filling rate(PFR) between on-line ABD system and the gated cardiac blood pool scinitigraphy. METHOD: 27 patients with an apical 4 chamber view of LV in which at least 75% of the endocardium was clearly seen were selected for this study. They had a normal sinus rhythm and underwent echocardiographic study on the same day of or one day before gated cardiac blood pool scintigraphic study. The off-line estimation of LV volume was performed by the method of disc, after manually tracing the endocardial border on the apical 4 chamber view and EFoff was calculated. Also on that view the ABD system was turned on, and EFABD, PEABD, PEABD were calculated automatically from LV volume curve. They were compared with EFRI, PERRI, and PERRI obtained by the gated cardiac blood pool scintigraphy. RESULTS: 1) EFoff and EFABD were highly correlated with EFRI(r=0.78, 0.90 respectively : p<0.001). The mean difference between EFRI and EFoff was 4+/-9%, and the limits of agreement between EFRI and EFoff were -16~22%, EFoff were less than EFRI(p<0.05). The mean difference between EFRI and EFABD was 5+/-7%, and the limits of agreement between EFRI and EFoff were -9~+19%. EFABD was also less than EFRI(p<0.05). 2) PERABD and PERABD were highly correlated with PERRI and PERRI(r=0.74, 0.60, respectively ; p<0.001). The mean difference between PERRI and PERABD was -0.1+/-0.7EDV(enddiastolic volume)/sec, and the limits of agreement were -1.5~+1.3EDV/sec. PEABD was slightly greater than PERRI(p>0.05). The mean difference between PERRI and PEABD was -0.8+/-0.8EDV/sec, and the limits of agreement were -2.4~+0.8EDV/sec. PEABD were greater than PERRI(p<0.01). CONCLUSION: EF, PER, PER measurements by the ABD system and the gated cardiac blood pool scintigraphy have significant correlations. Thus ABD echocardiography is a useful method for assessement of LV function.
Echocardiography* ; Endocardium ; Gated Blood-Pool Imaging* ; Humans ; Ventricular Function, Left*

OBJECTIVE: The aim of this study is to predict spontaneous labor onset delivery within 7 days in low risk pregnant women at 38 weeks' of gestation by ultrasonographic examination of cervical changes. MATERIAL AND METHODS: This prospective study included 110 singleton low risk pregnancies between 37(+0) and 37(+6) weeks of gestation. Fifteen cases were lost during follow-up and finally 95 pregnant women (58 nulliparous, 37 multiparous) were analysed. The study period was from Oct/2005 to May/2007. Four cervical changes (length, gland thickness, funneling and canal formation) were evaluated. Main outcome was remaining day to delivery after the examination. Remaining days to actual delivery with spontaneous labor onset were recorded and the pregnancies were divided into two groups according to remaining days (within 7 days, over 7 days) to compare predicting power of delivery within 7 days. ROC curves were drawn to find out cut-off values of cervical length and gland thickness. Sensitivity, specificity, positive predictive value and negative predictive value were extracted from four cervical changes. RESULTS: Mean cervical length of pregnant women at 38 weeks' of gestation was 25.8 (+/-10.0) mm and mean cervical gland thickness was 4.3 (+/-1.2) mm. Funnelings of uterine cervix were detected in 13 cases (13.7%), canal formations in 6 cases (6.3%). All four cervical changes were statistically valuable to predict delivery within 7 days and the cervical length showed highest sensitivity. When the cervical length was measured under 20 mm, the possibility of delivery within 7 days was 78.6% (p<0.001). The cervical gland thickness less than 4 mm could predict the delivery within 7 days with sensitivity of 57.1% (p<0.01). Sensitivities of funneling and canal formation for delivery within 7 days were 54.5%, 36.4% each. CONCLUSION: Ultrasonographic examination of the cervical changes in low risk singleton pregnancy at 38 weeks' of gestation are valuable for predicting spontaneous labor onset delivery within 7 days. Among four cervical changes, cervical length is most sensitive ultrasonographic marker.
Cervix Uteri ; Female ; Follow-Up Studies ; Humans ; Labor Onset ; Parturition* ; Pregnancy* ; Pregnant Women ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

No abstract available.
Humans ; Lung Neoplasms* ; Lung*

No abstract available.
Aminophylline* ; Humans* ; Neutrophils* ; Pneumonia* ; Sepsis* ; Superoxides*

PURPOSE: To evaluate the efficacy of tadiation therapy and eatrafascial hysterectomy in bulky stage lB,lla-B uterine cervix cancers. MATERIALS AND METHODS: Twenty four patients with bulky stage lB and llA-B carcinoma of the uterine cervix were treated with extrafascial hysterectomy following radiation therapy due to doubts of residual disease at Department of therapeutic radiology, Keimyung University, Dongsan Hospital , From April 1986 to December 1997. According to FIGO staging system, there were 7 Patients with stage lB, 9 patients with llA and 8 patients with llB stage whose median age was 45. Pathologic distribution showed 16 patients with squamous cell carcinoma and 8 with adenocarcinoma. Seven patients had tumors that are less than 5Cm in size 17 patients had tumors with larger than 5Cm.The mean interval between radiation therapy and extrafascial hysterectomy was 57 days. The radiation therapy consisted of irradition to the whole pelvis (180 cGy/fraction, Mean 4100 cGy)and parametrial boost ( for a mean total dose of 5000cGy) with midline shield (4x10Cm), followed by intracavitary irradiation up to 7500 cGy to point A (maximum 8500cGy). The maximum follow up duration was 107 months and mean follow up duration was 42 months. RESULTS: Ten out 24 patients (41.7%)had residual disease found at the time of eatrafascial hysterectomies. Five year Overall survival rate (5Y OSR) and five year disease free survival rate (5Y DFSR) were 63.6% and 62.5% respectively . Five year overall survial rate for stage lB and llA was 71.4% and 50% for stage llB. There was a significant difference in 5Y OSR and 5Y DFSR between patients with and those without residual disease (negative vs Positive, 83.3% vs. 40% (p=0.01), 83.3% vs36% (p=0.01) respectively). There was a notable tendency of better survival with adenocarcinoma than with squamous cell carcinoma (adenocarcinoma vs squamous cell carcinoma, 85.7% vs. 53.3% (p=0.1), 85.7% vs. 50.9% (p=0.1) of 5Y OSR and 5T DFS respectivey). Total dose to A point did not make a significant difference in survival rate or the existence of residual lesion (<7500 cGy, > or =7500 cGy). It was also noted that significantly more frequent local have occurred in patients with positive residual residual disease compared with negative residual disease (5/10 vs. 0/14, p=0.003). There was no death related to treatment. CONCLUSION:T here was no improvement of residual and to the overall survial rate in sqite of increased total dose to point A. We conclude that there is a possible beneficial of radiation therapy follow by extrafascial hysterectomy in survival for adenocarcinoma of bulky stage lB and llA-B uterine cervix. We need to this with follow up and large number of patients.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Hysterectomy* ; Pelvis ; Radiation Oncology ; Survival Rate