We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time.
Airway Extubation* ; Elasticity ; Gastrectomy ; Hoarseness ; Humans ; Intubation ; Middle Aged ; Recurrent Laryngeal Nerve ; Trachea ; Traction ; Vocal Cord Paralysis* ; Vocal Cords ; Voice

No abstract available.

BACKGROUND: Melanin pigment plays a major role in the expression of normal human skin color as well as in the photoprotection against ultraviolet damage. Melanin produced in melanocytes is transferred via dendrites to surrounding keratinocytes, and this anatomical relationship is termed as epidermal melanin unit. The rates of pigment synthesis and transfer by melanocytes appear to be influenced by ultraviolet light, though the precise factors regulating human epidermal pigmentation remain unelucidated. It has been reported that keratinocytes in vitro release factors that could modulate melanocyte behavior. Ultraviolet irradiation was also been known to enhance the release of various kinds of cytokine from keratinocytes in vivo and in vitro. OBJECTIVE: We postulated that keratinocytes rather than melanocytes could play a primary role in UVB-induced pigmentation, and keratinocytes, when irradiated with UVB, release substances that could modulate or stimulate melanin synthesis from melanocytes. The fact that keratinocytes are located efficiently for direct sunlight irradiation at the top of melanocytes, that they release various biological factors known to simulate melanin synthesis from melanocytes and that they constitute the majority of epidermal cells supported this possibility. To investigate this possibility, we evaluated the effect of supernatant from UVB-irradiated cultured keratinocytes on the growth, melanin content, and tyrosinase activity of human melanocytes. METHODS: Human cultured keratinocytes were irradiated with UVB(30, 60, or 120mj/cm2)once, and after 24 hours, supernatant of the keratinocytes were collected and added to a growth medium of melanocytes for 5 days in concentration of 15, 25 or 35%, We observed numeric and morphologic changes as well as melanin content and tyrosinase activity in situ of cultured human melanocytes. RESULTS: 1. When cultured melanocytes were incubated with supernatant of non-irradiated keratinocytes, the number of melanocytes, amount of melanin and tyrosinase activity increased in groups added with 25% or35% concentration of supernatant. 2. The number of melanocytes incubated with 15% or 25% concentrations of supernatant from cultured keratinocytes irradiated with UVB increased in both 30 and 60mj/cm2 of UVB irradiated groups and decreased in 120mJ/cm2of UVB irradiated groups. 3. The melanin content of melanocytes incubated with 15% concentration of supernatant from UVB-irradiated cultured keratinocytes increased in 120mJ/cm2 of UVG irradiated groups. 4. The tyrosinase activity of melanocytes incubated with 15% concentration of supernatant from UVB-irradiated cultured keratinocytes increased in 120mJ/cm2 of UVB irradiated groups and the tyrosinase activity of melanocytes incubated with 25% concentration of supernatant from UVB-irradiated cultured keratinocytes increased with 35% supernatant concentration of supernatant from UVB-irradiated keratinocytes, the tyrosinase activity increased in 30mJ/cm2of UVB irradiated groups. CONCLUSION: The above results suggest that UVB-irradiated kerationcytes release soluble or photoactivated factors which could modulate the growth and melanization of melanocytes, and that keratinocytes play an important or primary role in the regulation of UVB induced pigmentation.
Biological Factors ; Dendrites ; Humans* ; Keratinocytes* ; Melanins* ; Melanocytes* ; Monophenol Monooxygenase* ; Pigmentation ; Skin ; Sunlight ; Ultraviolet Rays

Successful repair of lacerated tendons must restore continuity of the tendon and should yield a strong tenorrhaphy. Mechanical strength of repair should be adequate to early postoperative motion and mobility, The optimal repair technique must be able to withstand the rigors of early motion and also must not interfere with tendon healing. The relative strength of three suture methods of lacerated tendon were measured by mechanical disruption in effort to determine the strength of suture technique. Fifty-four Calcaneal tendons of 27 the New Zealand white rabbit were transected at mid portion and repaired with the three suture technique: group 1, Kessler suture, group 2, Pennington’s modified-Kessler suture and group 3, augmented- Becker suture technique. Each group was composed of 18 calcaneal tendons. Nine rabbits were sacrified immediately after suture, nine in postoperative 2 weeks and nine in postoperative 4 weeks Six calcaneal tendons in each three experimental group were obtained immediately after suture, at postoperative 2 and 4 weeks respectively. Tensile strength, maximum strength and modulus of elasticity of all experimental specimens were measured with Instron-UTM-4-100(Toyo-Baldiwin, Japan). The results were evaluated statistically to compare the strength of the three suture technique at three different periods. The tensile strength was predominantly strongest in augmented-Becker method among three suture technique at immediate suture, postoperative 2 weeks and 4 weeks respectively. The augmented Becker repair was strongest in maximum stress among Kessler and modified Kessler repair at immediate operation, postoperative 2 weeks and 4 weeks respectively. The augmented Becker repair was highest in modulus of elasticity than Kessler method and modified-Kessler method at immediate operation, postoperative 2 weeks and postoperative 4 weeks respectively. Tensile strength, maximum stress and modulus of elasticity were gradually increased from immediate operation to postoperative 4 weeks, but there were not statistically significance between experimental three suture methods at postoperative 4 weeks.
Elastic Modulus ; Methods ; New Zealand ; Rabbits ; Suture Techniques ; Sutures ; Tendons ; Tensile Strength

Thrombotic thrombocytopenic purpura (TTP) can cause serious morbidity and mortality, and differentiating between this disease and systemic lupus erythematosus (SLE) can prove challenging. Although rare, TTP accompanied by SLE is linked to several complications and a higher mortality rate. Herein, we report a case of a 16-year-old boy who presented with systemic symptoms, such as petechiae, and was diagnosed with acquired TTP following a laboratory test. Steroid treatment was initiated and a diagnosis of SLE was reached after the symptoms had improved. Treatment with low-dose prednisone in addition to hydroxychloroquine was continued. The patient did not develop renal failure or neurologic deficit. No specific symptoms were observed after treatment and during the follow-up period. Early treatment of SLE is crucial, but it is difficult to reach an early diagnosis because the symptoms are similar to those of TTP. In the current study, an early diagnosis of TTP led to prompt treatment, thereby avoiding the fatal symptoms that could be caused by SLE.

BACKGROUND: Morbidity and mortality rates from acute respiratory failure remain noteworthy despite advances in conventional ventilatory techniques and improvements in supportive care. Repeated, the large tidal volume breaths during positive pressure mechanical ventilation lead to destruction of alveoli and pulmonary capillaries. Moreover, the overdistention of terminal lung units is considered as an important mechanism of ventilator induced lung injury. High frequency ventilation (HFV) is a technique involving a small tidal volume, and a higher than physiologic respiratory rate. Partial liquid ventilation (PLV), also known as perfluorocarbon-associated gas exchange, is a new technique for respiratory support. This study was designed to compare conventional mechanical ventilation (CMV) and high frequency jet ventilation (HFJV), in combination with PLV. METHODS: Twenty rabbits were anesthetized with xylazine, ketamine and vecuronium. We studied rabbits with lung injury induced by saline lavage. Animal were randomized into one of two treatment groups. Ventilator parameters included the following; CMV: FIO2 of 1.0, respiratory rate 20-30 breaths/min, I/E ratio 1 : 1; HFJV: respiratory rate 2 Hz, driving pressure 2psi. Animals were briefly disconnected from the ventilator and lungs were lavaged with warmed saline. This procedure was repeated until PaO2 < 100 mmHg. After one hour, we initiated the instillation of perfluorodecalin via an endotracheal tube. Baseline measurements were performed at 60 mins after the induction of anesthesia and repeated again at hour after the induction of lung injury, which included 30 mins of stabilization. After PFD instillation, data were recorded. RESULTS: All animals developed hypoxemia after the lung injury, but oxygenation improved significantly after perfluorodecalin instillation. The PLV-HFJV group showed a high pH and a low PaCO2. Mean arterial pressure, cardiac index and systemic vascular resistance was differed significantly. Although there were no qualitative histological differences between lungs ventilated with HFJV on CMV, the lower lobes of all PLV-treated animals were damaged less than the upper lobes, but without statical significance. CONCLUSIONS: PLV-HFJV produced a more efficient gas exchange than PLV-CMV. No significant difference was observed in the pulmonary pathologies of the groups.
Anesthesia ; Animals ; Anoxia ; Arterial Pressure ; Capillaries ; High-Frequency Jet Ventilation* ; High-Frequency Ventilation ; Hydrogen-Ion Concentration ; Ketamine ; Liquid Ventilation* ; Lung Injury* ; Lung* ; Mortality ; Oxygen ; Pathology ; Rabbits ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Rate ; Therapeutic Irrigation ; Tidal Volume ; Vascular Resistance ; Vecuronium Bromide ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical ; Xylazine

Measurement of the bulbocavernosus reflex is widely used to diagnose underlying neurologic disorders in erectile dysfunction. Because this single parameter of latency time in BCRL(bulbocavernosus reflex latency) testing has been used as the sole guideline to diagnose neurogenic impotence, problems in discriminating neurological disturbance from nonneurogenic impotence are frequently encountered especially when the value of latency time is within the borderline range, or when the outcome is difficult to interpret. In order to assess the useful parameters of conventional BCRL testing for the differential diagnosis of neurogenic impotence, we performed BCRL testing in 100 patients who compliance of poor erection. We compared these patients with a previously controlled group of 45 adult males without any erectile or neuronal disturbance. The results obtained were summarized as follows. . 1)Of 100 patients, 24 were diagnosed as neurogenic impotence. 2) In this neurogenic impotence group, as compared to the normal and non-neurogenic impotence group, there was a significant difference(P<0.05) in the values of sensory, pain, reflex threshold and bulbocavernosus reflex latency time. 3) The BCR measurement allowed to find lateralized neurologic disturbance. These results show that in BCRL testing the evaluated values of sensory, pain and reflex threshold, in addition to latency time, can be useful parameters for the differential diagnosis of neurogenic impotence.
Adult ; Compliance ; Diagnosis* ; Diagnosis, Differential ; Erectile Dysfunction* ; Humans ; Male ; Nervous System Diseases ; Neurons ; Reflex*

Recently, mobile health care has been applied to manage diabetes requiring self-management. Health care by mobile applications (apps) has a great advantage when applied to patients with diabetes; the adherence to self-management activities for diabetes can be improved through mobile apps. The Food and Drug Administration (FDA) has cleared and approved the use of some mobile apps as medical devices for the management of diabetes since 2010. However, mobile apps may not be effective for all patients. We here report the effect of use of mobile-based diabetes care app (Healthy-note app) for 2 patients with diabetes, and discuss issues and strategies for effective mobile intervention. Further study is needed on improving patient's participation to increase the effect of management via a mobile app.
Delivery of Health Care ; Diabetes Mellitus ; Humans ; Mobile Applications* ; Self Care ; Smartphone ; Telemedicine ; United States Food and Drug Administration

Lipidomics coverage improvement is essential for functional lipid and pathway construction.A powerful approach to discovering organism lipidome is to combine various data acquisitions,such as full scan mass spectrometry(full MS),data-dependent acquisition(DDA),and data-independent acquisition(DIA).Caenorhabditis elegans(C.elegans)is a useful model for discovering toxic-induced metabolism,high-throughput drug screening,and a variety of human disease pathways.To determine the lipidome of C.elegans and investigate lipid disruption from the molecular level to the system biology level,we used integrative data acquisition.The methyl-tert-butyl ether method was used to extract L4 stage C.elegans after exposure to triclosan(TCS),perfluorooctanoic acid,and nanopolystyrene(nPS).Full MS,DDA,and DIA integrations were performed to comprehensively profile the C.elegans lipidome by Q-Exactive Plus MS.All annotated lipids were then analyzed using lipid ontology and pathway analysis.We annotated up to 940 lipids from 20 lipid classes involved in various functions and pathways.The biological in-vestigations revealed that when C.elegans were exposed to nPS,lipid droplets were disrupted,whereas plasma membrane-functionalized lipids were likely to be changed in the TCS treatment group.The nPS treatment caused a significant disruption in lipid storage.Triacylglycerol,glycerophospholipid,and ether class lipids were those primarily hindered by toxicants.Finally,toxicant exposure frequently involved numerous lipid-related pathways,including the phosphoinositide 3-kinase/protein kinase B pathway.In conclusion,an integrative data acquisition strategy was used to characterize the C elegans lipidome,providing valuable biological insights into hypothesis generation and validation.

The microphthalmia-associated transcription factor (MITF), has been described as the master regulator of the basic helix-loop-helix leucine zipper family, involves melanogenesis in melanocytes. MITF consists of at least six isoforms, called MITF-M, MITF-A, MITF-B, MITF-C, MITF-H, and MITF-J. Previously, we found that not only MITF-M is expressed in the human hair follicle, but also MITF-A, MITF-C, MITF-H, and MITF-J isoforms are expressed in the skin. The aim of this study was to conform the MITF isoforms expressed in human skin, and investigate novel role of MITF isoforms in the melanocytes. Expression of MITF-M and MITF-A was found in primary melanoctyes and the melanoma cell lines. Interestingly, when MITF-M and MITF-A were overexpressed in the SK-MEL-24 melanoma cells by adenoviral transfection, length of the dendrites, serves as the principal conduit for melanosomes transfer, was significantly increased in the MITF-M overexpressed cells compared with the control group, and number of the dendtrites was significantly increased in the MITF-A overexpressed cells. A signal molecule involve in actin polymerization during dendrite formation, Rac1, was increased in the SK-MEL-24 melanoma cells treated with adenoviral MITF-M and MITF-A vectors. These results suggest that MITF-M and MITF-A induce dendrite formation via Rac1 signaling in the melanocytes.
Actins ; Cell Line ; Dendrites ; Hair Follicle ; Humans ; Leucine Zippers ; Melanocytes* ; Melanoma ; Melanosomes ; Microphthalmia-Associated Transcription Factor ; Polymerization ; Polymers ; Protein Isoforms ; Skin ; Transfection