Cyclophosphamide is alkylating agent used in the treatment of various solid tumors. Mucosal irritation by acrolein, the metabolite of cyclophosphamide, is believed to cause various symptoms of cystitis. The thiol compound, sodium 2-mercaptoethane sulfonate (Mesna), has been found to inactivate acrolein. We present an unusual case of a 64-year-old woman, who was treated as chronic cystitis. Her symptoms did not improve, so she was treated with Mesna under the assumption of cyclophosphamide induced cystitis; her symptoms then improved.
Acrolein ; Cyclophosphamide* ; Cystitis* ; Female ; Humans ; Mesna* ; Middle Aged ; Sodium

14-3-3zeta is related to many cancer survival cellular processes. In a previous study, we showed that silencing 14-3-3zeta decreases the resistance of hepatocellular carcinoma (HCC) to chemotherapy. In this study, we investigated whether silencing 14-3-3zeta affects the radioresistance of cancer stem-like cells (CSCs) in HCC. Knockdown of 14-3-3zeta decreased cell viability and the number of spheres by reducing radioresistance in CSCs after gamma-irradiation (IR). Furthermore, the levels of pro-apoptotic proteins were upregulated in CSCs via silencing 14-3-3zeta after IR. These results suggest that 14-3-3zeta knockdown enhances radio-induced apoptosis by reducing radioresistance in liver CSCs.
14-3-3 Proteins/genetics/*metabolism ; Antigens, CD/genetics/*metabolism ; Apoptosis Regulatory Proteins/genetics/metabolism ; Carcinoma, Hepatocellular/genetics/metabolism ; Cell Line, Tumor ; *Gamma Rays ; Glycoproteins/genetics/*metabolism ; Humans ; Liver Neoplasms/genetics/metabolism ; Neoplastic Stem Cells/metabolism/*radiation effects ; Peptides/genetics/*metabolism ; *Radiation Tolerance

Objective: Overcrowded emergency departments (ED) are a worldwide problem, which could cause treatment delays and increased mortality of patients. This study aimed at evaluating the effect of admission decisions by emergency physicians without consultation of an internal medicine doctor on the emergency department length of stay (ED LOS) and survival rate of patients diagnosed with medical disease. Methods: The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions, implemented in July 2017. During and after the policy change, emergency physicians took decisions on the arrangements and treatment for patients by processing their admission and providing follow-up care without further specialist consultations. The ED LOS and rate of admission to the IM department were compared between the study period (October 2017 to October 2018) and the control period (June 2016 to June 2017). Results: The median ED LOS of patients admitted to the IM department decreased from 164.0 minutes (interquartile range [IQR], 118.0-234.0) in the control period to 114.0 minutes (IQR, 104.0-208.0) in the study period. After propensity score matching, the median ED LOS of patients admitted to the IM department decreased from 187.0 minutes (IQR, 136.0-253.0) in the control period to 144.0 minutes (IQR, 104.0-208.0) in the study period. Conclusion The admission decisions made by emergency physicians reduced the ED and hospital LOS of patients visiting the ED and diagnosed with medical disease.

Objective: This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation. Methods: A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation. Results: The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001). Conclusion The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.

Objective: Overcrowded emergency departments (ED) are a worldwide problem, which could cause treatment delays and increased mortality of patients. This study aimed at evaluating the effect of admission decisions by emergency physicians without consultation of an internal medicine doctor on the emergency department length of stay (ED LOS) and survival rate of patients diagnosed with medical disease. Methods: The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions, implemented in July 2017. During and after the policy change, emergency physicians took decisions on the arrangements and treatment for patients by processing their admission and providing follow-up care without further specialist consultations. The ED LOS and rate of admission to the IM department were compared between the study period (October 2017 to October 2018) and the control period (June 2016 to June 2017). Results: The median ED LOS of patients admitted to the IM department decreased from 164.0 minutes (interquartile range [IQR], 118.0-234.0) in the control period to 114.0 minutes (IQR, 104.0-208.0) in the study period. After propensity score matching, the median ED LOS of patients admitted to the IM department decreased from 187.0 minutes (IQR, 136.0-253.0) in the control period to 144.0 minutes (IQR, 104.0-208.0) in the study period. Conclusion The admission decisions made by emergency physicians reduced the ED and hospital LOS of patients visiting the ED and diagnosed with medical disease.

Objective: This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation. Methods: A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation. Results: The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001). Conclusion The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.

Urinary tract infection is common in the pediatric population. The most common causative agents are bacteria, among which Escherichia coli is the most frequent uropathogen. Although fungal urinary tract infection is rare in the healthy pediatric population, it is relatively common among hospitalized patients. Fungus may be isolated from the urine of immunocompromised patients or that of patients with indwelling catheters. The most common cause of funguria is Candida albicans. Although more than 50% of Candida isolates belong to non-albicans Candida , the prevalence of non-albicans candiduria is increasing. Herein, we report a case of community-acquired candiduria in a 4-month-old immunocompetent male infant who had bilateral vesicoureteral reflux and was administered antibiotic prophylaxis. He was diagnosed with urinary tract infection caused by Candida lusitaniae and was managed with fluconazole.
Antibiotic Prophylaxis ; Bacteria ; Candida ; Candida albicans ; Catheters, Indwelling ; Escherichia coli ; Fluconazole ; Fungi ; Humans ; Immunocompromised Host ; Infant ; Male ; Prevalence ; Urinary Tract Infections ; Urinary Tract ; Vesico-Ureteral Reflux

BACKGROUND/AIMS: The investigation of a specific tumor marker for hepatocellular carcinoma (HCC) is needed to examine the carcinogenesis and to select the patients for treatment options. The aim of this study was to find the genes related to HCC. We also examined the expression level of these genes in cancer cell lines and tissue specimens. METHODS: Three pairs of HCC tissue and non-neoplastic hepatic tissue around the HCC were collected from three patients who underwent resection for HCC. Differential display reverse transcriptase-PCR (DD RT-PCR) using GeneFishing (TM) PCR was used to detect the differences in the gene expression between in HCC tissue and non-neoplatic tissue. Up- or down-regulated genes in HCC tissue were identified through BLAST searches after cloning and sequencing assays. Real-time RT-PCR assay was employed to detect the expression rate in 11 HCC tissues and human cancer cell lines. RESULTS: Differentially expressed 21 genes were identified, and they were classified as genes involved in protein metabolism, ubiquitin-dependent protein catabolism, carbohydrate metabolism, lipid metabolism, DNA repair, and inflammatory response. CONCLUSIONS: We identified differentially expressed genes in HCC, and these genes may play an important role in the study of hepatocarcinogenesis, development of biomarker, and target therapy for HCC.
Carcinoma, Hepatocellular/diagnosis/genetics/*metabolism ; Cell Line, Tumor ; Down-Regulation ; Gene Expression Regulation, Neoplastic ; Humans ; Liver Neoplasms/diagnosis/genetics/*metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA ; Tumor Markers, Biological/genetics/*metabolism ; Up-Regulation

Nonalcoholic steatohepatitis (NASH) is characterized by hepatocyte injury and inflammatory cell infiltration, which has been linked to peripheral insulin resistance and increased levels of triglycerides in the liver. The purposes of this study were to establish a mouse model of NASH by feeding mice a 60% high-fat diet (HFD) and to demonstrate the anti-fibrotic effects of oleuropein, which has been shown to have anti-oxidant and anti-inflammatory properties, in this HFD-induced mouse model of NASH. C57BL/6 mice were divided into three groups: a regular diet group (Chow), a HFD group and an oleuropein-supplemented HFD group (OSD), which was fed a 0.05% OSD for 6 months. The effects of oleuropein in this model were evaluated using biochemical, histological and molecular markers. The expression levels of alpha-smooth muscle actin (alpha-SMA)and collagen type I in the HFD and OSD groups were evaluated using real-time PCR and western blotting. The body weight, biochemical marker levels, nonalcoholic fatty liver disease activity score, homeostasis model of assessment-insulin resistance (HOMA-IR) and leptin levels observed in the HFD group at 9 and 12 months were higher than those observed in the Chow group. The HOMA-IR and leptin levels in the OSD group were decreased compared with the HFD group. In addition, alpha-SMA and collagen type I expression were decreased by oleuropein treatment. We established a NASH model induced by HFD and demonstrated that this model exhibits the histopathological features of NASH progressing to fibrosis. Our results suggest that oleuropein may be pharmacologically useful in preventing the progression of steatohepatitis and fibrosis and may be a promising agent for the treatment of NASH in humans.
Actins/genetics/metabolism ; Animals ; Antihypertensive Agents/*therapeutic use ; Collagen Type I/genetics/metabolism ; Diet, High-Fat/*adverse effects ; Fatty Liver/*drug therapy/etiology/metabolism ; Fibrosis/etiology/metabolism/prevention & control ; Iridoids/*therapeutic use ; Leptin/genetics/metabolism ; Liver/metabolism/pathology ; Mice ; Mice, Inbred C57BL

BACKGROUND/AIMS: The role of Elk-3 in the epithelial-mesenchymal transition (EMT) during liver fibrogenesis remains unclear. Here, we determined the expression of Elk-3 in in vitro and in vivo models and in human liver fibrotic tissues. We also investigated the molecular relationships among Elk-3, early growth response-1 (Egr-1), and the mitogen activated protein kinases (MAPK) pathway during EMT in hepatocytes. METHODS: We established anin vitro EMT model in which normal mouse hepatocyte cell lines were treated with transforming growth factor (TGF)-β1 and a CCl4-induced liver fibrosis model. Characteristics of EMT were determined by evaluating the expression levels of related markers. The expression of Elk-3 and its target Egr-1 were analyzed using Western blotting. Gene silencing of Elk-3 was performed using an siRNA knockdown system. RESULTS: The expression levels of mesenchymal markers were increased during TGF-β1-induced EMT of hepatocytes. The expression levels of Elk-3 and Egr-1 were significantly (p<0.05) increased during the EMT of hepatocytes, in CCl₄-induced mouse liver fibrotic tissues, and in human liver cirrhotic tissues. Silencing of Elk-3 and inhibition of the Ras-Elk-3 pathway with an inhibitor suppressed the expression of EMT-related markers. Moreover, Elk-3 expression was regulated by p38 MAPK phosphorylation during EMT. CONCLUSIONS: Elk-3 contributes to the progression of liver fibrosis by modulating the EMT via the regulation of Egr-1 under MAPK signaling.
Animals ; Blotting, Western ; Cell Line ; Epithelial-Mesenchymal Transition* ; Gene Silencing ; Hepatocytes ; Humans ; In Vitro Techniques ; Liver Cirrhosis* ; Liver* ; Mice ; Mitogen-Activated Protein Kinases ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; RNA, Small Interfering ; Transforming Growth Factors