BACKGROUND: Reusable Proseal(TM) laryngeal mask airways (PLMAs) can act as a vector for the transmission of prion diseases such as variant Creutzfeldt-Jacob disease. This study tested the hypothesis that supplementary ultrasonic cleaning facilitates the removal of protein deposits on PLMAs after anesthesia. METHODS: After clinical use, 40 PLMAs were randomly allocated into two groups. In the first group, the PLMAs were washed by hand and were then subsequently placed in an autoclave at 134degrees C for 40 min (Group 1, n = 20). In the second group, the PLMAs were washed by hand and ultrasonic cleaning using an enzymatic solution for 5 min, and were then subsequently placed in an autoclave (Group 2, n = 20). In both groups, protein deposits were detected on PLMAs by erythrosin staining. A staining score designated as none (0%), mild (0-20%), moderate (20-80%) and severe (80-100%), was assigned to each site (outer surface, inner surface and edges of the cuff, airway and drain tube, finger strap) according to the percentage of the stained surface area. RESULTS: Despite the cleaning of the masks, residual protein was found on the outer surface, inner surface and edge of the cuff, airway and drain tube, and finger strap of the PLMAs in both groups. Similar scores were observed for each part of the cleaned PLMAs in both groups, except for the outer surface of the PLMAs in Group 2 (P < 0.05). CONCLUSIONS: We conclude that the use of an ultrasonic cleaner with an enzymatic solution may be effective to cleanse the outer surface of the PLMAs, but there were no differences in the total scores for both groups.
Erythrosine ; Fingers ; Hand ; Laryngeal Masks ; Masks ; Prion Diseases ; Proteins ; Ultrasonics

PURPOSE: We studied the results of urine cultures and antimicrobial sensitivity tests according to the voiding method used by spinal cord injury (SCI) patients over a recent 10-year period. MATERIALS AND METHODS: We retrospectively analyzed 1,236 urine samples and their antimicrobial sensitivity tests for 112 patients who had used only one voiding method between January 2000 and December 2009. The voiding methods were classified into four groups: clean intermittent catheterization (CIC), suprapubic catheterization, urethral Foley catheter, and spontaneous voiding. RESULTS: Of the 1,236 urine samples, 925 (74.8%) were positive and 279 (30.2%) had more than one bacteria. The CIC group showed the lowest rate of bacteriuria, colony counts, and polymicrobial infection (p<0.001). Causative organisms were mostly Gram-negative bacteria (84%), including Pseudomonas aeruginosa (22.9%), Escherichia coli (21.1%), Klebsiella species (6.7%), and Citrobacter species (6.3%). The rate of Gram-positive bacterial infection was 13.6%, and major pathogenic organisms were Streptococcus species (8.6%) and Staphylococcus species (2.6%). Major pathogenic organisms and the results of antimicrobial sensitivity tests differed according to the voiding method. CONCLUSIONS: Although the patient's condition and preferences are important when choosing the method of bladder management, CIC is the best voiding method for reducing urinary tract infections in SCI patients. When immediate use of antibiotics is needed for treatment of urinary tract infections, an appropriate antibiotic can be chosen according to the voiding method on the basis of our study and can be administered before the results of an antimicrobial sensitivity test are available.
Anti-Bacterial Agents ; Bacteria ; Bacteriuria ; Catheters ; Citrobacter ; Coinfection ; Escherichia coli ; Gram-Negative Bacteria ; Gram-Positive Bacterial Infections ; Humans ; Intermittent Urethral Catheterization ; Klebsiella ; Microbial Sensitivity Tests ; Pseudomonas aeruginosa ; Retrospective Studies ; Spinal Cord ; Spinal Cord Injuries ; Staphylococcus ; Streptococcus ; Urinary Bladder ; Urinary Catheterization ; Urinary Tract Infections

Macrophages play a role in innate immune responses to various foreign antigens. Many products from primary tumors influence the activation and transmigration of macrophages. Here, we investigated a migration of macrophages stimulated with cancer cell culture-conditioned medium (CM). Macrophage activation by treatment with CM of B16F10 cells were judged by the increase in protein levels of inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX2). The location where macrophages were at 4 h-incubation with control medium or CM was different from where they were at 5 h-incubation in culture dish. Percentage of superimposed macrophages at every 1 h interval was gradually increased by CM treatment as compared to control. Total coverage of migrated track expressed in coordinates was smaller and total distance of migration was shorter in CM-treated macrophages than that in control. Rac1 activity in CM-treated macrophages was also decreased as compared to that in control. When macrophages were treated with CM in the presence of dexamethasone (Dex), an increase in COX2 protein levels, and a decrease in Rac1 activity and total coverage of migration were reversed. In the meanwhile, biphasic changes were detected by Dex treatment in section distance of migration at each time interval, which was more decreased at early time and then increased at later time. Taken together, data demonstrate that macrophage motility could be reduced in accordance with activation in response to cancer cell products. It suggests that macrophage motility could be a novel marker to monitor cancer-associated inflammatory diseases and the efficacy of anti-inflammatory agents.
Anti-Inflammatory Agents ; Cell Movement* ; Cyclooxygenase 2 ; Dexamethasone ; Immunity, Innate ; Macrophage Activation ; Macrophages* ; Nitric Oxide Synthase Type II ; Track and Field

BACKGROUND AND OBJECTIVES: Exercise myocardial perfusion scans in patients with hypertrophic cardiomyopa-thy have shown reversible perfusion abnormalities with unknown clinical significance. We performed this study to characterize dipyridamole Tl-201 SPECT imaging and correlate with clinical findings in patients with hyper-trophic cardiomyopathy. METHODS: Tl-201 SPECT was performed in 25 patients of hypertrophic cardiomyopa-thy with asymmetric septal hypertrophy and 20 normal controls after dipyridamole infusion (0.56 mg/kg). Myocardial wall was divided into 8 segments. Tl-201 uptake and relative washout rate were calculated. RESULTS: Tl-201 SPECT showed significantly lower Tl-201 uptake in basal septal (81.3+/-3.4% vs 78.2+/-6.4%, p<0.05) and apical septal wall on stress (88.2+/-4.7% vs 83.9+/-6.5%, p<0.05) and higher apical septal (86.6+/-5.2% vs 89.2+/-3.1%, p<0.05) and apical anterior wall uptake (88.7%+/-4.0% vs 91.4+/-4.9%, p<0.05) on redistribution images in patients with hypertrophic cardiomyopathy. Basal lateral wall uptake of hypertrophic cardiomyopathy was significantly lower than normal control on both stress (84.7+/-3.5% vs 81.2+/-7.3%, p<0.05) and redistribution images (85.0+/-5.8% vs 76.8+/-7.2%, p<0.0001). The septum/lateral uptake ratio of patients on rest image was significantly higher than that of normal controls (0.98+/-0.07 vs 1.07+/-0.10, p<0.001). There was no difference in age, sex, symptom, cardiac medication and the parameters of 2D-echo including left ven-tricular outflow obstruction between subgroups of normal vs abnormal washout in patients with hypertrophic cardiomyopathy. CONCLUSION: Dipyridamole Tl-201 myocardial SPECT shows reduced coronary vasodilatory capacity of myocardium, especially septum in patients with hypertrophic cardiomyopathy. High septal/lateral uptake ratio on redistribution image may be a characteristic finding. However, no correlation between abnorm-al Tl-201 washout and clinical findings was observed.
Cardiomyopathies ; Cardiomyopathy, Hypertrophic* ; Dipyridamole* ; Humans ; Myocardium ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*

Vascular endothelial growth factor (VEGF) is an important regulator of neovascularization. Hypoxia inducible nitric oxide (NO) enhanced the expression of VEGF and thymosin beta-4 (Tbeta4), actin sequestering protein. Here, we investigated whether NO-mediated VEGF expression could be regulated by Tbeta4 expression in HeLa cervical cancer cells. Hypoxia inducible NO production and VEGF expression were reduced by small interference (si) RNA of Tbeta4. Hypoxia response element (HRE)-luciferase activity and VEGF expression were increased by the treatment with N-(beta-D-Glucopyranosyl)-N2-acetyl-S-nitroso-D, L-penicillaminamide (SNAP-1), to generate NO, which was inhibited by the inhibition of Tbeta4 expression with Tbeta4-siRNA. In hypoxic condition, HRE-luciferase activity and VEGF expression were inhibited by the treatment with N(G)-monomethyl-L-arginine (L-NMMA), an inhibitor to nitric oxide synthase (NOS), which is accompanied with a decrease in Tbeta4 expression. VEGF expression inhibited by L-NMMA treatment was restored by the transfection with pCMV-Tbeta4 plasmids for Tbeta4 overexpression. Taken together, these results suggest that Tbeta4 could be a regulator for the expression of VEGF via the maintenance of NOS activity.
Actins ; Anoxia ; Nitric Oxide Synthase ; Nitric Oxide* ; omega-N-Methylarginine ; Plasmids ; Response Elements ; RNA ; Thymosin* ; Transfection ; Uterine Cervical Neoplasms* ; Vascular Endothelial Growth Factor A*

"Purple toe" syndrome is an extremely rare complication of warfarin therapy. The occurrence of purple toe syndrome is characterized by a sudden appearance of purplish discoloration of toes and the sides of feet. The skin lesions usually develop 3-8 weeks after beginning anticoagulation. The pathogenesis was not clearly defined but the presence of atherosclerosis in most of patients led to suggest that the mechanism was related to cholesterol emboli from the atherosclerotic plaques and warfarin- induced bleeding into the plaques. These microemboli are commonly associated with irreversible organ dysfunction such as renal failure, distal gangrene, pancreatitis, and multifocal myocardial necrosis. Therefore purple toe syndrome may be considered as a sentinel of cholesterol crystal embolism. Once established, anticoagulation and thrombolysis are contraindicated. Necrosis and gangrenous changes may result in loss of limb and occasional mortality has been reported. We report a case of purple toe syndrome associated with acute renal failure after warfarin therapy with a review of literatures.
Acute Kidney Injury* ; Atherosclerosis ; Cholesterol ; Embolism ; Embolism, Cholesterol ; Extremities ; Foot ; Gangrene ; Hemorrhage ; Humans ; Mortality ; Necrosis ; Pancreatitis ; Plaque, Atherosclerotic ; Renal Insufficiency ; Skin ; Toes* ; Warfarin*

BACKGROUND: Many reports suggest that cervical sympathectomy improves cerebral blood flow. But the basal & medial areas of brain are innervated bilaterally, so unilateral sympathectomy may not improve the outcome of infarction of those areas effectively. Actually it was reported that only bilateral, not unilateral cervical sympathectomy increased the blood flow of thalamus which known to be innervated bilaterally, and also reported that unilateral sympathectomy did not reduce the infarct size of caudate nucleus. So we studied the effect of bilateral superior cervical sympathectomy on focal cerebral infarction. METHODS: Twenty rabbits were divided into two groups. In the sham-operated control group (n=10), focal infarction was achieved by administering an autologous blood clot into the internal carotid artery after exposure of bilateral superior cervical sympathetic ganglia. In the sympathectomy group (n=10), bilateral superior cervical sympathetic ganglia were excised following embolization. Seven hours after embolization, brains were sliced into 2 mm coronal sections, stained with 2,3,5-triphenyltetrazolium chloride, and infarct sizes were determined via image analysis. RESULTS: There were no differences in the physiologic variables between two groups. The percentage of infarct size was significantly greater in the control group as compared to the sympathectomy group in both cortex (23+/-8% vs 12+/-5%, respectively; P<0.05) and subcortical area (35+/-8% vs 17+/-8%, respectively; P<0.05). CONCLUSIONS: These results suggest that bilateral superior cervical sympathectomy may reduce the infarct size of subcortical area as well as of cerebral cortex measured at 7 hours following induction of focal cerebral infarction.
Brain ; Carotid Artery, Internal ; Caudate Nucleus ; Cerebral Cortex ; Cerebral Infarction* ; Ganglia, Sympathetic ; Infarction ; Rabbits* ; Sympathectomy* ; Thalamus

The aim of the present study was to identify the influence of vertebral fracture (VF) on the functional disability in patients with rheumatoid arthritis (RA). This study consecutively enrolled 100 female patients aged 50 yr or older with RA. All participants underwent lateral imaging of the thoracolumbar spine by simple radiography to identify any VFs. They also completed questionnaires via interview regarding demographics, medical history, and disease outcomes including functional disability. We used univariate analysis to evaluate associations between functional disability and VF, and made multivariate logistic regression models to test independent effect of the presence of VF, the number of VFs, and the severity of VF on functional disability. Among the 100 RA patients, 47 had at least one VF, but 34 of them were asymptomatic that they had experienced a fracture. The multiple VFs > or = 3 (OR, 8.95; 95% CI, 1.77-44.15, P = 0.01) and moderate or severe VF (OR, 3.38; 95% CI, 1.26-9.04, P = 0.02) were related to disability in univariate analysis. The multiple VFs > or = 3 (OR, 6.13; 95% CI, 1.02-36.94, P = 0.048) was associated with functional disability of RA patients after adjusting various confounders and it was mainly in walking and arising. The VF might be an important factor which affects functional disability in RA patients.
Aged ; Arthritis, Rheumatoid/complications/*diagnosis ; Demography ; *Disability Evaluation ; Female ; Humans ; Interviews as Topic ; Logistic Models ; Middle Aged ; Odds Ratio ; Questionnaires ; Spinal Fractures/complications/*diagnosis/radiography

BACKGROUND: Postopertative nausea and vomiting (PONV) are frequent and distressing side effects of surgery. Even though many drugs has been developed, PONV still remains unsolved problem. Ondansetron is a commonly used 5-HT3 receptor antagonist. It acts through specific binding to the 5-HT3A, 5-HT3B receptor complex. We hypothesized that patients with genetic variation in 5-HT3A receptor might have variable incidence of PONV and respond differently to ondansetron. METHODS: We included 204 patients undergoing gynecologic laparoscopic surgery. PONV were documented during 24 hours after operation. Ondansetron was injected to every patient who had PONV at PACU and PONV reassessed after 15 minutes. DNA was extracted from blood and 5-HT3A Pro16Ser missense mutation was analyzed by using real-time PCR. RESULTS: The incidence of PONV were 50% for wild type, 53% for heterozygote and 0% for homozygote. There were no significant differences between wild type and heterozygote in VAS of nausea and VAS change after ondansetron. CONCLUSIONS: 5-HT3A receptor Pro16Ser polymorphism is not associated with the incidence of PONV and the response to ondansetron in Korean patients.
DNA ; Genetic Variation ; Heterozygote ; Homozygote ; Humans ; Incidence ; Laparoscopy ; Mutation, Missense ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Real-Time Polymerase Chain Reaction ; Receptors, Serotonin, 5-HT3 ; Vomiting

OBJECTIVE: Survivin is a novel inhibitor of apoptosis. Suppression of apoptosis is important for carcinogenesis and tumor growth. The purpose of this study was to investigate whether survivin is expressed in the tissues of normal uterine cervix, cervical intraepithelial neoplasia grade III (CIN III) and squamous cell carsinoma of the uterine cervix, as a first step for evaluation of the clinical significance of survivin in uterine cervical cancer. METHODS: We investigated the expression of survivin in the tissues of 11 cases of normal uterine cervix and 14 cases of CIN III and 20 cases of uterine cervical cancer, using Immunohistochemistry at department of obstetrics and gynecology of Ajou university hospital from Jan. 2000 to Jan. 2001 and then compared with the results of three groups. RESULTS: The expression of survivin is increased significantly in cases of CIN III and uterine cervical cancer compared with controls. (p<0.05, One way ANOVA test) CONCLUSION: This study shows survivin could play an important role in the carcinogenesis mechanism of uterine cervix. And further study will be followed to evaluate the clinical relationship of survivin in uterine cervical cancer and whether to act a prognostic factor or not.
Apoptosis ; Carcinogenesis ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Female ; Gynecology ; Immunohistochemistry ; Obstetrics ; Uterine Cervical Neoplasms