PURPOSE: Previous studies have shown that treatment with Smilax china L. leaf extract (SCLE) produces antidiabetic effects due to alpha-glucosidase inhibition. In this study, we examined the mechanism underlying these antidiabetic effects by examining glucose uptake in HepG2 cells cultured with SCLE. METHODS: Glucose uptake and glucokinase activity were examined using an assay kit. Expression of glucose transporter (GLUT)-2, GLUT-4, and HNF-1alpha was measured by RT-PCR or western blot. RESULTS: Treatment with SCLE resulted in enhanced glucose uptake in HepG2 cells, and this effect was especially pronounced when cells were cultured in an insulin-free medium. SCLE induced an increase in expression of GLUT-2 but not GLUT-4. The increase in the levels of HNF-1alpha, a GLUT-2 transcription factor, in total protein extract and nuclear fraction suggest that the effects of SCLE may occur at the level of GLUT-2 transcription. In addition, by measuring the change in glucokinase activity following SCLE treatment, we confirmed that SCLE stimulates glucose utilization by direct activation of this enzyme. CONCLUSION: These results demonstrate that the potential antidiabetic activity of SCLE is due at least in part to stimulation of glucose uptake and an increase in glucokinase activity, and that SCLE-stimulated glucose uptake is mediated through enhancement of GLUT-2 expression by inducing expression of its transcription factor, HNF-1alpha.
Absorption* ; alpha-Glucosidases ; Blotting, Western ; China* ; Glucokinase ; Glucose Transport Proteins, Facilitative ; Glucose* ; Hep G2 Cells* ; Hepatocyte Nuclear Factor 1-alpha ; Smilax* ; Transcription Factors

BACKGROUND: Recently, video-assisted thoracoscopic surgery(VATS) has been accepted as the standard treatment for spontaneous pneumothorax. However, comparatively high recurrent rate and cost-effectiveness are still controversial. The recurrent rate after bullectomy with VATS is reported to be as high as 5-10% whereas it is below 2% in thoracotomy. There is no statistical report on cost-effectiveness in Korean health care system. Material and METHOD: Our retrospective analysis was performed on 173 cases of surgically treated primary spontaneous pneumothorax at Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, from January 1997 to July 1999. There were 104 cases VATS and 69 cases of thoracotomy. We analysed the operative indication, gender, operating time, amounts of the staples used, tube drainage, tube stay time, postoperative complications, recurrent rate, operation room cost, and total cost. RESULT: Operation time was 71.3 +/-29.5minutes in VATS group and 141 +/-52minutes in thoracotomy group(P<0.05). The postoperative tube stay and hospital stay are 3.93days and 7.5days in VATS group and 7.0 days and 13.4days in thoracotomy group, respectively(P<0.05, P<0.05). The number of recurrence after the operation in VATS group(6/104, 5.6%) was significantly higher than in thoracotomy group (1/69, 1.4%; P<0.05). The operation room cost was significantly higher in VATS group than in thoracotomy group (won 1,202,192 +/-178,992, won 1,005,669 +/-311,531; P<0.05), but considering the total cost, there was no significant difference between the two groups( won 1,946,110 +/- 487,440, won 1,793,912 +/-308,079; P=0.18). CONCLUSION: Although operative procedure and discharge policy may affect the recurrent rate and cost, there was no benefit of cost-effectiveness in VATS group and recurrent rate was higher in VATS group than in throacotomy group. It would be helpful to set up a prospective trial comparing cost and results of VATS versus minithoracotomy.
Cost-Benefit Analysis ; Delivery of Health Care ; Drainage ; Humans ; Length of Stay ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy*

PURPOSE: Poncirus trifoliata has been reported to have anti-inflammatory, antioxidant, and immune activities. However, its anti-obesity activity and the mechanism by which the water extract of dried, immature fruit of Poncirus trifoliata (PF-W) acts are not clear. This study suggests a potential mechanism associated with the anti-obesity activity of PF-W. METHODS: We measured the effect of PF-W on lipoprotein lipase (LPL) regulation using enzyme-linked immunosorbent assay (ELISA) and an activity assay. The LPL regulation mechanism was examined by reverse transcription polymerase chain reaction (RT-PCR) to measure the mRNA expression of biomarkers related to protein transport and by western blot for analysis of the protein expression of the transcription factor CCAAT-enhancer-binding protein (C/EBPbeta) RESULTS: The total polyphenol and flavonoid content of PF-W was 52.15 +/- 4.02 and 6.56 +/- 0.47 mg/g, respectively. PF-W treatment decreased LPL content in media to 58 +/- 5% of that in control adipocyte media, and increased LPL content to 117 +/- 3.5% of that in control adipocytes, but did not affect the mRNA expression of LPL. PF-W also increased the mRNA expression of sortilin-related receptor (SorLA), a receptor that induces endocytosis and intracellular trafficking of LPL, in a concentration- and time-dependent manner. Finally, cell fractionation revealed that PF-W treatment induced the expression of C/EBPbeta, a SorLA transcription factor, in the nuclei of 3T3-L1 adipocytes. CONCLUSION: The LPL secretion and activity assay showed PF-W to be an LPL secretion inhibitor, and these results suggest the potential mechanism of PF-W involving inhibition of LPL secretion through C/EBPbeta-mediated induction of SorLA expression.
Adipocytes ; Biomarkers ; Blotting, Western ; CCAAT-Enhancer-Binding Proteins ; Cell Fractionation ; Endocytosis ; Enzyme-Linked Immunosorbent Assay ; Fruit ; Lipoprotein Lipase* ; Polymerase Chain Reaction ; Poncirus* ; Protein Transport ; Reverse Transcription ; RNA, Messenger ; Transcription Factors ; Water*

BACKGROUNDS/AIMS: We investigated the clinical application of extended distal pancreatectomy in patients with pancreatic neck cancer accompanied by distal pancreatic atrophy. In this study, we have emphasized on the technical aspects of using the linear stapling device for a bulky target organ. METHODS: From March 2010 to September 2013, 46 patients with pancreatic adenocarcinoma, who underwent pancreatic resection with radical intent at our institute, were reviewed retrospectively. Among them, three patients (6.5%) underwent extended distal pancreatectomy. A linear stapling device and vise-grip locking pliers were used for en bloc resection of the distal pancreas, first duodenal portion, and distal common bile duct. The results were compared with those after standard pancreatectomy. RESULTS: All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5. Grade A pancreatic fistula developed in all of the cases, but none of these fistulae were lethal. Pathological staging was T3N1M0 in all of the patients. The postoperative daily serum glucose fluctuations and insulin requirements were comparable to those in patients who received pancreaticoduodenectomy or distal pancreatectomy. At the last follow-up, two patients were alive with liver metastasis at 4 and 10 months postoperatively, respectively, and one patient died of liver metastasis at 5 months postoperatively. CONCLUSIONS: While the prognosis of advanced pancreatic neck adenocarcinoma is still dismal, extended distal pancreatectomy is a valid treatment option, especially when there is atrophy of the distal pancreas. Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.
Adenocarcinoma ; Atrophy ; Blood Glucose ; Common Bile Duct ; Fistula ; Follow-Up Studies ; Head and Neck Neoplasms* ; Humans ; Insulin ; Jaundice ; Liver ; Neck ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy* ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies

BACKGROUNDS/AIMS: The post-operative complications and clinical course of pancreaticoduodenectomy (PD) largely depend on the pancreaticojejunostomy (PJ). Several methods of PJ are in clinical use. We analyzed the early results of binding pancreaticojejunostomy (BPJ), a technique reported by SY Peng. METHODS: We retrospectively reviewed the clinical results of patients who received BPJ in Inha University Hospital from 2006 to 2011. 21 BPJs were performed with Peng's method. The definition of postoperative pancreatic fistula (PF) was a high amylase content (>3 times the upper normal serum value) of the drain fluid (of any measurable volume), at any time on or after the 3rd post-operative day. The pancreatic fistula was graded according to the International Study Group for Pancreatic Fistula (ISGPF) guidelines. RESULTS: Of the 21 patients who received BPJ, 11 were male. The median age was 61.2 years. PD surgery included 4 cases of Whipple's procedures and 17 cases of pylorus-preserving PD. According to the post-operative course, 16 patients recovered well with no evidence of PF. A total of 5 patients (23.8%), including 3 grade A PFs and 2 grade C PFs, suffered from a pancreatic fistula. 3 patients with grade A PF recovered with conservative management. CONCLUSIONS: The BPJ appears to be a relatively safe procedure based on this preliminary study, but further study is needed to validate its safety.
Amylases ; Humans ; Male ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Retrospective Studies

The prevalence of parasitic infections was investigated in human immunodeficiency virus (HIV)-infected patients (n = 105) who visited Seoul National University Hospital, Seoul, Korea, during the period from 1995 to 2003. Fecal samples were collected from 67 patients for intestinal parasite examinations, and sputum or bronchoalveolar lavage samples from 60 patients for examination of Pneumocystis carinii. Both samples were obtained from 22 patients. Thirty-three (31.4%) of the 105 were found to have parasitic infections; Cryptosporidium parvum (10.5%; 7/67), Isospora belli (7.5%; 5/67), Clonorchis sinensis (3.0%; 2/67), Giardia lamblia (1.5%; 1/67), Gymnophalloides seoi (1.5%; 1/67), and Pneumocystis carinii (28.3%; 17/60). The hospital records of the 11 intestinal parasite-infected patients showed that all suffered from diarrhea. This study shows that parasitic infections are important clinical complications in HIV-infected patients in the Republic of Korea.
AIDS-Related Opportunistic Infections/*parasitology ; Adult ; Feces/parasitology ; Female ; HIV Infections/*complications ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Parasitic Diseases/*epidemiology ; Research Support, Non-U.S. Gov't

BACKGROUND: Paraplegia remains unresolved as the most dreaded operative complication with surgical treatment of descending thoracic and thoracoabdominal aortic diseases. In this study, the neuroprotective effect of trimetazidine that has been used clinically for ischemic heart disease was investigated in a rabbit spinal cord ischemia model. MATERIAL AND METHOD: Thirty-three New Zealand white rabbits were randomized as follows: control group undergoing abdominal aortic occlusion but receiving no pharmacologic intervention(Group 1, n=17); TMZ group(Group 2, n=16) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta. Ischemia was induced by clamping the abdominal aorta just distal to the left renal artery for 30 minutes. Neurologic status was assessed at 2, 24, and 48 hours after the operation according to the modified Tarlov scale, then the lumbosacral spinal cord was processed for histopathologic examinations 48 hours after the final assessment. RESULT: The average motor function score was significantly higher in the TMZ group(3.20 +/- 0.77 vs 1.13 +/- 1.25 at 2 hours, 3.50 +/- 0.76 vs 1.45 +/- 1.57 at 24 hours, and 3.91 +/- 0.30 vs 1.86 +/- 1.86 at 48 hours after operation; p value Aorta ; Aorta, Abdominal ; Aortic Diseases ; Constriction ; Ischemia ; Myocardial Ischemia ; Neuroprotective Agents ; Paraplegia ; Rabbits ; Renal Artery ; Spinal Cord Injuries ; Spinal Cord Ischemia* ; Spinal Cord* ; Trimetazidine*

BACKGROUND: Paraplegia remains unresolved as the most dreaded operative complication with surgical treatment of descending thoracic and thoracoabdominal aortic diseases. In this study, the neuroprotective effect of trimetazidine that has been used clinically for ischemic heart disease was investigated in a rabbit spinal cord ischemia model. MATERIAL AND METHOD: Thirty-three New Zealand white rabbits were randomized as follows: control group undergoing abdominal aortic occlusion but receiving no pharmacologic intervention(Group 1, n=17); TMZ group(Group 2, n=16) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta. Ischemia was induced by clamping the abdominal aorta just distal to the left renal artery for 30 minutes. Neurologic status was assessed at 2, 24, and 48 hours after the operation according to the modified Tarlov scale, then the lumbosacral spinal cord was processed for histopathologic examinations 48 hours after the final assessment. RESULT: The average motor function score was significantly higher in the TMZ group(3.20 +/- 0.77 vs 1.13 +/- 1.25 at 2 hours, 3.50 +/- 0.76 vs 1.45 +/- 1.57 at 24 hours, and 3.91 +/- 0.30 vs 1.86 +/- 1.86 at 48 hours after operation; p value Aorta ; Aorta, Abdominal ; Aortic Diseases ; Constriction ; Ischemia ; Myocardial Ischemia ; Neuroprotective Agents ; Paraplegia ; Rabbits ; Renal Artery ; Spinal Cord Injuries ; Spinal Cord Ischemia* ; Spinal Cord* ; Trimetazidine*

PURPOSE: Long-acting gonadotropin-releasing hormone agonists (GnRHa) are commonly used to treat central precocious puberty (CPP) in Korea. Although rare, there have been reports on the characteristic of adverse reactions of GnRHa in CPP among the Korean population. This study was intended to report on our clinical experience regarding significant adverse reactions to long-acting GnRHa in CPP and early onset puberty and to evaluate the prevalence rate of serious side effects. METHODS: This retrospective study included children with CPP and early onset puberty, who were administered monthly with long-acting GnRHa (leuprolide acetate, triptorelin acetate) at the outpatient clinic of Department of Pediatrics, at Inha University Hospital, between January 2011 and December 2013. We analyzed the clinical characteristics of patients who experienced significant adverse reactions and evaluated the prevalence rate. RESULTS: Six serious side effects (0.9%) were observed among total of 621 CPP and early onset puberty children with GnRHa therapy. The number of sterile abscess formation was four in three patients (4 events of 621). Anaphylaxis occurred in only one patient, and unilateral slipped capital femoral epiphysis (SCFE) in another one patient. Anaphylaxis occurred after the 6th administration of the monthly depot triptorelin acetate. Unilateral SCFE developed in GnRHa therapy. CONCLUSION: Sterile abscess formation occurred in 0.6% of CPP and early onset puberty patients from the administration of a monthly depot GnRHa therapy. The occurrences of anaphylaxis and SCFE are extremely rare, but can have serious implications on patients. Clinicians should be aware of these potential adverse effects related to GnRHa therapy in CPP.
Abscess ; Adolescent ; Ambulatory Care Facilities ; Anaphylaxis ; Child ; Drug-Related Side Effects and Adverse Reactions ; Gonadotropin-Releasing Hormone* ; Humans ; Korea ; Leuprolide ; Pediatrics ; Prevalence ; Puberty* ; Puberty, Precocious* ; Retrospective Studies ; Slipped Capital Femoral Epiphyses ; Triptorelin Pamoate

PURPOSE: Totally implantable venous access devices (TIVADs) are commonly used in pediatrics for the administration of chemotherapy, antibiotics, or parenteral nutrition. TIVADs can be implanted using various techniques, including surgical cutdown (SC) and percutaneous puncture (PP). Recently, percutaneous TIVAD became popular in adults, but studies comparing between PP and SC group in pediatric patients are rare. MATERIALS AND METHODS: Data were collected and analyzed retrospectively from 23 patients who underwent TIVAD at a single institution between January 2013 and December 2015. We examined the clinical characteristics, insertion techniques, and clinical outcome. We divided the patients into 2 groups and compared PP with ultrasonography and SC using the insertion technique. We compared success rate, procedural time, and the patency rate between the 2 groups. RESULTS: Eleven TIVADS were inserted using PP, and 12 TIVADs were inserted using SC. No statistically significant difference in characteristics was found between the 2 groups. The procedural time in the PP group was shorter than that in the SC group, but the difference was not statistically significant (P=0.685). During follow-up, 1 patient in the SC group had an occlusion, and 1 patient in the PP group had an infection. CONCLUSION: PP of the internal jugular vein with ultrasonography appears to be the method of choice for TIVAD insertion owing to its similar success rate in terms of implantation and complication rate to that in SC, with shorter procedural times in pediatric patients.
Adult ; Anti-Bacterial Agents ; Catheters ; Drug Therapy ; Follow-Up Studies ; Humans ; Jugular Veins ; Methods ; Parenteral Nutrition ; Pediatrics ; Punctures* ; Retrospective Studies ; Ultrasonography ; Vascular Access Devices