Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.

Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.

Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.

Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.

Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.

Interleukin (IL)-20, a proinflammatory cytokine of the IL-10 family, is involved in acute and chronic renal failure. The aim of this study was to elucidate the role of IL-20 during diabetic nephropathy development. We found that IL-20 and its receptor IL-20R1 were upregulated in the kidneys of mice and rats with STZ-induced diabetes. In vitro, IL-20 induced MMP-9, MCP-1, TGF-β1 and VEGF expression in podocytes. IL-20 was upregulated by hydrogen peroxide, high-dose glucose and TGF-β1. In addition, IL-20 induced apoptosis in podocytes by activating caspase-8. In STZ-induced early diabetic nephropathy, IL-20R1-deficient mice had lower blood glucose and serum BUN levels and a smaller glomerular area than did wild-type controls. Anti-IL-20 monoclonal antibody (7E) treatment reduced blood glucose and the glomerular area and improved renal functions in mice in the early stage of STZ-induced diabetic nephropathy. ELISA showed that the serum IL-20 level was higher in patients with diabetes mellitus than in healthy controls. The findings of this study suggest that IL-20 induces cell apoptosis of podocytes and plays a role in the pathogenesis of early diabetic nephropathy.
Animals ; Apoptosis ; Blood Glucose ; Caspase 8 ; Diabetes Mellitus ; Diabetic Nephropathies* ; Enzyme-Linked Immunosorbent Assay ; Glucose ; Humans ; Hydrogen Peroxide ; In Vitro Techniques ; Interleukin-10 ; Interleukins ; Kidney ; Kidney Failure, Chronic ; Mice ; Podocytes* ; Rats ; Vascular Endothelial Growth Factor A

Excessive microglial activation and subsequent neuroinflammation lead to synaptic loss and dysfunction as well as neuronal cell death, which are involved in the pathogenesis and progression of several neurodegenerative diseases. Thus, the regulation of microglial activation has been evaluated as effective therapeutic strategies. Although dieckol (DEK), one of the phlorotannins isolated from marine brown alga Ecklonia cava, has been previously reported to inhibit microglial activation, the molecular mechanism is still unclear. Therefore, we investigated here molecular mechanism of DEK via extracellular signal-regulated kinase (ERK), Akt and nicotinamide adenine dinuclelotide phosphate (NADPH) oxidase-mediated pathways. In addition, the neuroprotective mechanism of DEK was investigated in microglia-mediated neurotoxicity models such as neuron-microglia co-culture and microglial conditioned media system. Our results demonstrated that treatment of anti-oxidant DEK potently suppressed phosphorylation of ERK in lipopolysaccharide (LPS, 1 microg/ml)-stimulated BV-2 microglia. In addition, DEK markedly attenuated Akt phosphorylation and increased expression of gp91(phox), which is the catalytic component of NADPH oxidase complex responsible for microglial reactive oxygen species (ROS) generation. Finally, DEK significantly attenuated neuronal cell death that is induced by treatment of microglial conditioned media containing neurotoxic secretary molecules. These neuroprotective effects of DEK were also confirmed in a neuron-microglia co-culture system using enhanced green fluorescent protein (EGFP)-transfected B35 neuroblastoma cell line. Taken together, these results suggest that DEK suppresses excessive microglial activation and microglia-mediated neuronal cell death via downregulation of ERK, Akt and NADPH oxidase-mediated pathways.
Adenine ; Cell Death* ; Cell Line ; Coculture Techniques ; Culture Media, Conditioned ; Down-Regulation ; Microglia ; NADP* ; NADPH Oxidase ; Neuroblastoma ; Neurodegenerative Diseases ; Neurons* ; Neuroprotective Agents ; Niacinamide ; Phosphorylation ; Phosphotransferases ; Reactive Oxygen Species

PURPOSE: To investigate the care patterns for radiation therapy and to determine inter-hospital differences for patients with laryngeal carcinoma in Korea. MATERIALS AND METHODS: A total of 237 cases of laryngeal carcinoma (glottis, 144; supraglottis, 93) assembled from 23 hospitals, who underwent irradiation in the year of 1998 and 1999, were retrospectively analyzed to investigate inter-hospital differences with respect to radiotherapy treatment. We grouped the 23 hospitals based on the number of new patients annually irradiated in 1998; and designated them as group A (> or =900 patients), group B (> or =400 patients and <900 patients), and group C (<400 patients). RESULTS: The median age of the 237 patients was 62 years (range, 25 to 88 years), of which 216 were male and 21 were female. The clinical stages were distributed as follows: for glottis cancer, I; 61.8%, II; 21.5%, III; 4.2%, IVa; 11.1%, IVb; 1.4%, and in supraglottic cancer, I; 4.3%, II; 19.4%, III; 28.0%, IVa; 43.0%, IVb; 5.4%, respectively. Some differences were observed among the 3 groups with respect to the dose calculation method, radiation energy, field arrangement, and use of an immobilization device. No significant difference among 3 hospital groups was observed with respect to treatment modality, irradiation volume, and median total dose delivered to the primary site. CONCLUSION: This study revealed that radiotherapy process and patterns of care are relatively uniform in laryngeal cancer patients in Korean hospitals, and we hope this nationwide data can be used as a basis for the standardization of radiotherapy for the treatment of laryngeal cancer.
Female ; Glottis ; Humans ; Immobilization ; Korea ; Laryngeal Neoplasms ; Male ; Retrospective Studies

PURPOSE: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. MATERIALS AND METHODS: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. RESULTS: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. CONCLUSION: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.
Academies and Institutes ; Acute Pain ; Analgesics ; Female ; Fentanyl* ; Humans ; Male ; Nausea ; Prospective Studies ; Quality of Life ; Radiotherapy* ; Sleep Initiation and Maintenance Disorders ; Transdermal Patch*

PURPOSE: Nonparasitic hepatic cyst is being increasingly found due to the frequent application of diagnostic imaging. The treatment for nonparasitic hepatic cysts varies according to the nature of the lesion. Many authors have recently reported the benefit of performing laparoscopic unroofing for nonparasitic hepatic cyst. In this study, we reviewed the indications and the results of open surgery and laparoscopic unroofing for nonparasitic hepatic cyst. METHODS: From May 1992 until May 2005, 28 patients underwent an operation for nonparasitic hepatic cyst in our hospital. 12 patients had open surgery and 16 patients had laparoscopic unroofing. The indications and outcomes for open surgery and laparoscopic unroofing were compared. RESULTS: 25 patients were female and 3 patients were male, and the mean age was 59.7 (range: 35~80) years. Non- specific abdominal pain was the most common symptom in 74.4% (20/28) of the patients. The indications for open surgery included suspicious neoplastic cyst (3), hemorrhagic cyst (1), infected cysts (2), a huge cyst involving one lobe (1), cysts in segment 7 (2), and simple cysts that had been operated on before 1996 (2). Three suspicious neoplastic hepatic cysts turned out to be simple cysts on the pathology report. Laparoscopic unroofing was performed for 15 simple nonparasitic hepatic cysts and for one infected cyst. The mean hospital stay was 4.7 days (mean stay: 2~11) for the laparoscopic surgery patients compared to 16.2 days (mean tay: 7~38) for the open surgery patients (p< 0.0005). No morbidity or mortality was present in both groups. CONCLUSION: Laparoscopic unroofing for nonparasitic hepatic cyst is less invasive and it required a shorter hospital stay. Thus, laparoscopic unroofing is favored for the nonparasitic hepatic cyst unless it is complicated by neoplastic cysts.
Abdominal Pain ; Diagnostic Imaging ; Female ; Humans ; Laparoscopy ; Length of Stay ; Liver Diseases ; Male ; Mortality ; Pathology