PURPOSE: Postoperative cognitive dysfunction (POCD) is a complication of surgery characterized by acute cognitive dysfunction, memory impairment, and loss of attention. The effect of polydeoxyribonucleotide (PDRN) on the POCD environment induced by lipopolysaccharide (LPS) and sevoflurane exposure were investigated in human neuronal SH-SY5Y cells. METHODS: The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and WST-8 assays were performed to determine cell viability. Cyclic adenosine-3,5′-monophosphate (cAMP), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 concentrations were measured using enzyme-linked immunoassay (ELISA). Immunocytochemistry was performed for vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF), and western blotting for TNF-α, IL-1β, IL-6, and cAMP response element-binding protein (CREB). RESULTS: Induction of the POCD environment reduced cell viability in the MTT and WST-8 assays. PDRN treatment reduced TNF-α, IL-1β, and IL-6 expression in POCD conditions, and significantly increased cAMP concentrations and the p-CREB/CREB ratio. PDRN treatment activated adenosine A2A receptors and then increased the expression of VEGF and BDNF, which had been reduced by LPS and sevoflurane exposure. CONCLUSIONS PDRN treatment showed a therapeutic effect on the LPS and sevoflurane-induced POCD environment. PDRN was shown to have an excellent therapeutic effect on POCD, not only by promoting rapid anti-inflammatory effects in damaged cells, but also by enhancing the expression of BDNF and VEGF.

PURPOSE: Sleep deprivation induces depressive symptoms. Dexmedetomidine is a α2-adrenoreceptor agonist and this drug possesses sedative, anxiolytic, analgesic, and anesthetic-sparing effect. In this study, the action of dexmedetomidine on sleep deprivation-induced depressive behaviors was investigated using mice. METHODS: For the inducing of sleep deprivation, the mice were placed inside a water cage containing 15 platforms and filled with water up to 1 cm below the platform surface for 7 days. One day after sleep deprivation, dexmedetomidine at the respective dosage (0.5, 1, and 2 μg/kg) was intraperitoneally treated into the mice, one time per a day during 6 days. Then, forced swimming test and tail suspension test were conducted. Immunohistochemistry for tyrosine hydroxylase (TH), 5-hydroxytryptamine (5-HT; serotonin), tryptophan hydroxylase (TPH) and western blot for D1 dopamine receptor were also performed. RESULTS: Sleep deprivation increased the immobility latency in the forced swimming test and tail suspension test. The expressions of TPH, 5-HT, and D1 dopamine receptor were decreased, whereas, TH expression was increased by sleep deprivation. Dexmedetomidine decreased the immobility latency and increased the expressions of TPH, 5-HT, and D1 dopamine receptor, whereas, HT expression was decreased by dexmedetomidine treatment. CONCLUSIONS: In our results, dexmedetomidine alleviated sleep deprivation-induced depressive behaviors by increasing 5-HT synthesis and by decreasing dopamine production with up-regulation of D1 dopamine receptor.
Animals ; Blotting, Western ; Depression ; Dexmedetomidine* ; Dopamine ; Hindlimb Suspension ; Immunohistochemistry ; Mice* ; Physical Exertion ; Receptors, Dopamine ; Serotonin ; Sleep Deprivation ; Tryptophan Hydroxylase ; Tyrosine 3-Monooxygenase ; Up-Regulation ; Water

BACKGROUND/AIMS: Controversy still exists regarding the benefits of covered self-expandable metal stents (SEMSs) compared to uncovered SEMSs. We aimed to compare the patency and stent-related adverse events of partially covered SEMSs (PC-SEMSs) and uncovered SEMSs in unresectable malignant distal biliary obstruction. METHODS: A total of 134 patients who received a PC-SEMS or uncovered SEMS for palliation of unresectable malignant distal biliary obstruction were reviewed retrospectively. The main outcome measures were stent patency, stent-related adverse events, and overall survival. RESULTS: The median stent patency was 118 days (range, 3 to 802 days) with PC-SEMSs and 105 days (range, 2 to 485 days) with uncovered SEMSs (p=0.718). The overall endoscopic revision rate due to stent dysfunction was 36.6% (26/71) with PC-SEMSs and 36.5% (23/63) with uncovered SEMSs (p=0.589). Tumor ingrowth was more frequent with uncovered SEMSs (4.2% vs 19.1%, p=0.013), but migration was more frequent with PC-SEMSs (11.2% vs 1.5%, p=0.04). The incidence of stent-related adverse events was 2.8% (2/71) with PC-SEMSs and 9.5% (6/63) with uncovered SEMSs (p=0.224). The median overall survival was 166 days with PC-SEMSs and 168 days with uncovered SEMSs (p=0.189). CONCLUSIONS: Compared to uncovered SEMSs, PC-SEMSs did not prolong stent patency in unresectable malignant distal biliary obstruction. Stent migration was more frequent with PC-SEMSs. However, tumor ingrowth was less frequent with PC-SEMSs compared to uncovered SEMSs.
Humans ; Incidence ; Outcome Assessment (Health Care) ; Retrospective Studies ; Stents*

BACKGROUND/AIMS: Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients. METHODS: Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram. RESULTS: Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events. CONCLUSIONS: Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed.
Arrhythmias, Cardiac ; Cholangiopancreatography, Endoscopic Retrograde ; Colon ; Defibrillators, Implantable ; Electrocardiography ; Electrocardiography, Ambulatory ; Electrosurgery* ; Follow-Up Studies ; Humans ; Magnets ; Medical Records ; Outpatients ; Retrospective Studies ; SNARE Proteins ; Sphincterotomy, Endoscopic ; Tachycardia

No abstract available.
Bile Duct Neoplasms/*diagnosis/pathology ; Cystadenocarcinoma/*diagnosis/pathology ; Diagnostic Errors ; Humans ; Liver/pathology ; Liver Abscess/diagnosis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: The aims of the present study were to investigate the women's perspective on influenza infection and vaccination and to evaluate how they influence vaccine acceptability, in Korean women of childbearing age. METHODS: This was a prospective study by random survey of women of childbearing age (20 to 45 years). They were asked to complete a questionnaire assessing their knowledge, attitudes and acceptability of influenza vaccination before and during pregnancy. This study utilized data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2008 and 2012, to analyze the recent influenza vaccination trends. RESULTS: According to KNHANES (2008-2012), influenza vaccination rates in women of childbearing age have increased up to 26.4%, after 2009. The questionnaire was completed by 308 women. Vaccination rate during pregnancy or planning a pregnancy was 38.6%. The immunization rate increased significantly with the mean number of correct answers (P<0.001). Women who received influenza vaccination were more likely to be previously informed of the recommendations concerning the influenza vaccination before or during pregnancy, received the influenza vaccination in the past, and of the opinion that influenza vaccination is not dangerous during pregnancy, with odds ratios of 14.6 (95% confidence interval [CI], 6.44 to 33.33; P<0.0001), 3.6 (95% CI, 1.84 to 6.97; P=0.0002) and 2.7 (95% CI, 1.34 to 5.47; P=0.0057). CONCLUSION: Influenza vaccination rate in women of childbearing age has increased in this study and national data. More information and recommendation by healthcare workers, especially obstetricians, including safety of vaccination, might be critical for improving vaccination rate in women of childbearing age.
Delivery of Health Care ; Female ; Humans ; Immunization ; Influenza, Human* ; Korea ; Nutrition Surveys ; Odds Ratio ; Pregnancy ; Prospective Studies ; Surveys and Questionnaires ; Vaccination*

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.
Adult ; Cross-Sectional Studies ; Diphtheria ; Diphtheria-Tetanus-acellular Pertussis Vaccines/*administration & dosage ; Female ; Health Knowledge, Attitudes, Practice/*ethnology ; Humans ; Immunization/*statistics & numerical data ; Infant ; Logistic Models ; Multivariate Analysis ; Patient Acceptance of Health Care/*ethnology/statistics & numerical data ; Pregnancy ; Republic of Korea/epidemiology ; Risk ; Surveys and Questionnaires ; Tetanus ; Vaccination ; Whooping Cough/diagnosis/ethnology

BACKGROUND/AIMS: This study aimed to compare the outcomes of endoscopic submucosal dissection (ESD) and gastrectomy based on the two sets of indications for ESD, namely guideline criteria (GC) and expanded criteria (EC). METHODS: Between January 2004 and July 2007, 213 early gastric cancer (EGC) patients were enrolled in this study. Of these patients, 142 underwent ESD, and 71 underwent gastrectomy. We evaluated the clinical outcomes of these patients according to the criteria. RESULTS: The complication rates in the ESD and gastrectomy groups were 8.5% and 28.2%, respectively. The duration of hospital stay was significantly shorter in the ESD group than the gastrectomy group according to the GC and EC (p<0.001 and p<0.001, respectively). There was no recurrence in the ESD and gastrectomy groups according to the GC, and the recurrence rates in the ESD and gastrectomy groups were 4.7% and 0.0% according to the EC, respectively (p=0.279). The occurrence rates of metachronous cancer in the ESD and gastrectomy groups were 5.7% and 5.0% according to the GC (p=1.000) and 7.5% and 0.0% according to the EC (p=0.055), respectively. CONCLUSIONS: Based on safety, duration of hospital stay, and long-term outcomes, ESD may be an effective and safe first-line treatment for EGC according to the EC and GC.
Adult ; Aged ; Dissection ; Early Detection of Cancer ; *Endoscopy, Gastrointestinal ; Female ; *Gastrectomy ; Gastric Mucosa/*surgery ; Humans ; Length of Stay ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Patient Safety ; Retrospective Studies ; Stomach Neoplasms/*surgery/therapy ; Treatment Outcome

Diabetes mellitus is a known risk factor for Klebsiella pneumoniae liver abscess, and may be associated with metastatic complications. We report a case of diabetic ketoacidosis (DKA) precipitated by a K. pneumoniae liver abscess and followed by a brain abscess. A 31-year-old man with uncontrolled type 2 diabetes was admitted for DKA. Abdominal and pelvic computed tomography scans showed multiple abscesses in the lung, liver, both kidneys, and prostate gland. The blood culture yielded K. pneumoniae. The patient's condition improved following antibiotic and insulin therapy, and he was discharged. However, he was rehospitalized 10 days after discharge due to a generalized tonic-clonic seizure. Brain magnetic resonance imaging revealed a brain abscess in the right basal ganglia. The patient was given an intravenous injection of antibiotics (vancomycin and carbapenem), and he recovered well with no neurological sequelae.
Abscess ; Adult ; Anti-Bacterial Agents ; Basal Ganglia ; Brain ; Brain Abscess ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Humans ; Injections, Intravenous ; Insulin ; Kidney ; Klebsiella ; Klebsiella pneumoniae ; Liver ; Liver Abscess ; Lung ; Magnetic Resonance Imaging ; Pneumonia ; Prostate ; Risk Factors ; Seizures

Sweet's syndrome is characterized by a constellation of clinical symptoms, physical features, and pathologic findings, which include fever, leukocytosis, tender erythematous skin lesions, and a diffuse infiltrate consisting predominantly of mature neutrophils in the upper dermis. Pulmonary involvement in Sweet's syndrome is rare. In addition, a pleural effusion has been rarely reported in the pulmonary involvement of Sweet's syndrome. We report a case of Sweet's syndrome presenting with pulmonary involvement and a bilateral pleural effusion in a patient with myelodysplastic syndrome.
Dermis ; Fever ; Humans ; Leukocytosis ; Myelodysplastic Syndromes ; Neutrophils ; Pleural Effusion ; Skin ; Sweet Syndrome