Purpose: We investigated the antiadhesive effects of lidocaine, methylene blue, and atorvastatin, with a focus on preventing remote adhesions in a rat model of postoperative adhesions. Methods: Models were assigned to either the control group (saline infusion only) or treatment groups (group L, lidocaine;group M, methylene blue; or group S, atorvastatin). Adhesions were induced by intestinal or abdominal wall injuries. The rats were sacrificed 2 weeks after surgery. Results: The number of remote adhesions was markedly lower in groups L, M, and S than in the control group. The macroscopic adhesion score was substantially lower in groups L, M, and S than in the control group. Acute and chronic inflammation, as well as fibrosis scores, were also markedly lower in groups L, M, and S than in the control group. IL-1βlevels were considerably reduced in groups L, M, and S at 2 hours after surgery and remained substantially lower in group S at 48 hours. IL-6 levels were markedly reduced in groups M and S at 2 hours and in all treatment groups at 48 hours than in the control group. Conclusion Intraperitoneal administration of lidocaine, methylene blue, and atorvastatin effectively reduced remote adhesion formation, macroscopic and microscopic adhesion scores, and inflammatory cytokine levels in a rat adhesion model.

The integration of regional anesthesia (RA) with general anesthesia (GA) has become a central component of multimodal strategies to improve perioperative pain management. This approach not only enhances analgesic efficacy but also reduces opioid requirements and mitigates opioid-related adverse effects. By targeting peripheral or neuraxial nociceptive pathways, RA attenuates the surgical stress response and decreases central sensitization, complementing the systemic actions of GA. The combined application of RA and GA has shown substantial benefits across a wide range of surgical procedures, including abdominal, thoracic, orthopedic, and pediatric operations. Reported advantages include improved hemodynamic stability, enhanced pulmonary function, earlier ambulation, faster gastrointestinal recovery, and greater patient satisfaction. Moreover, recent evidence indicates a positive association between effective postoperative pain control and long-term outcomes, such as reduced incidence of persistent postsurgical pain, better functional independence, and even improved immune function and survival following cancer surgery. The development of sustained-release local anesthetic delivery systems, which provide localized and prolonged analgesia, further extends the benefits of RA-GA integration into the postoperative period. This review summarizes the mechanistic rationale, clinical applications, and future directions of RA-GA combinations in modern surgical care, with special emphasis on their role in enhanced recovery after surgery protocols.

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Purpose: This study investigated the effects of an intervention that combined the abdominal drawing-in maneuver and frequency-specific neuromuscular electrical stimulation on changes in trunk muscle activity, muscle fatigue, and balance in stroke patients. Methods: Thirty stroke patients were randomly assigned to two groups. Fifteen subjects were assigned to group I which performed the abdominal drawing-in maneuver combined with low-frequency neuromuscular electrical stimulation and the other 15 subjects to group II where the abdominal drawing-in maneuver was combined with high-frequency neuromuscular electrical stimulation. Muscle activity and fatigue were measured using surface electromyography before the intervention. Balance was measured using the Trunk Impairment Scale and re-measured after six weeks of intervention for comparative analysis. Results: Both groups showed a significant increase in muscle activity and balance (p < 0.05), and there was no significant difference between the groups (p > 0.05). In the changes in muscle fatigue, only the experimental group II showed a significant increase in muscle fatigue (p < 0.05). The difference between the groups was statistically significant (p < 0.05). Conclusion It was confirmed that among stroke patients, the combination of the abdominal drawing-in maneuver and low-frequency neuromuscular electrical stimulation was more effective in changing the muscle activity and balance of the trunk by minimizing the occurrence of muscle fatigue compared to the combination of the abdominal drawing-in maneuver and high-frequency stimulation. These results can be used as basic data for clinical trunk stabilization training.

Tuberculosis of the cystic duct lymph node is very rare. Only four cases have been reported in the literature. This paper presents the case of a young male patient with a tuberculous cystic duct lymph node and chronic cholecystitis, who was diagnosed with cystic duct stones and a gall bladder polyp preoperatively.

Purpose: A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods: We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results: The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.

Purpose: A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods: We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results: The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.

Objectives: To investigate the effect of nicotine on the healing of an oral cavity wound, high and low concentrations of nicotine were administered on human gingival fibroblasts. Methods: Nicotine at concentrations of 0.1, 1, 5, and 10 mM were administered to gingival fibroblasts to evaluate the survival capability of the cells. Nicotine at 0.1 mM, a nonapoptotic concentration, was administered to evaluate apoptosis using Annexin V-FITC/Propidium Iodide cell staining.Nicotine at 1, 10, and 100 mM were administered to measure the expression of inflammatory cytokines, which was measured by RT-PCR and ELISA. FGF was treated with an additional 1, 10, or 100 mM of nicotine to evaluate cell proliferation and wound healing. Results: As the concentration of nicotine increased (0.1, 1, 5, and 10 mM), the survival capability of the cells reduced. When cells were exposed to low nicotine concentration (0.1 mM) for 24 h, apoptosis occurred. Moreover, if the cell was exposed for 48 h, cell apoptosis occurred with necrosis. As the concentration of nicotine increased (1, 10, and 100 mM), more inflammatory cytokines were expressed. When EC LPS and TF LPS were combined with a low concentration of nicotine (1 and 10 mM), the expression of inflammatory cytokines was suppressed. The FGF level decreased as the nicotine concentration increased (1, 10, and 100 mM). Conclusions Nicotine interferes with the wound healing process of gingival fibroblasts. To maintain the wound healing process after a surgery or dental procedure, cessation of smoking is recommended.

Purpose: Radiation-induced oral mucositis limits delivery of high-dose radiation to targeted cancers. Therefore, it is necessary to develop a treatment strategy to alleviate radiation-induced oral mucositis during radiation therapy. We previously reported that inhibiting reactive oxygen species (ROS) generation suppresses autophagy. Irradiation induces autophagy, suggesting that antioxidant treatment may be used to inhibit radiation-induced oral mucositis. Materials and Methods: We determined whether treatment with N-acetyl cysteine (NAC) could attenuate radiation-induced buccal mucosa damage in vitro and in vivo. The protective effects of NAC against oral mucositis were confirmed by transmission electron microscopy and immunocytochemistry. mRNA and protein levels of DNA damage and autophagy-related genes were measured by quantitative real-time polymerase chain reaction and western blot analysis, respectively. Results: Rats manifesting radiation-induced oral mucositis showed decreased oral intake, loss of body weight, and low survival rate. NAC intake slightly increased oral intake, body weight, and the survival rate without statistical significance. However, histopathologic characteristics were markedly restored in NAC-treated irradiated rats. LC3B staining of rat buccal mucosa revealed that NAC treatment significantly decreased the number of radiation-induced autophagic cells. Further, NAC inhibited radiation-induced ROS generation and autophagy signaling. In vitro, NAC treatment significantly reduced the expression of NRF2, LC3B, p62, and Beclin-1 in keratinocytes compared with that after radiation treatment. Conclusion NAC treatment significantly inhibited radiation-induced autophagy in keratinocytes and rat buccal mucosa and may be a potentially safe and effective option for the prevention of radiation-induced buccal mucosa damage.

PURPOSE: The present study aimed to evaluate atypical lymph node metastasis rates according to tumor depth, size, and location in patients with gastric cancer.METHODS: A total of 727 gastric adenocarcinoma patients, with metastasis to 1 or 2 lymph nodes, who underwent radical gastrectomy with curative intent from May 2003 to May 2017, were enrolled in this study. The characteristics of atypical (skip or transversal) metastases were evaluated according to the following risk factors: longitudinal versus circumferential location, size, and T stage of the tumor.RESULTS: The rates of skip and transversal metastases were 8.4% and 15.5%, respectively. Skip metastases were present throughout, regardless of the primary tumor location. On the contrary, transversal metastases of gastric cancer were most frequently observed in the lower third region (19.5%, P=0.002). When the size of the tumor is large (>4 cm), transversal metastasis was found to be significantly more common (P=0.035), compared with skip metastasis, which was less common (P=0.011). There was no significant correlation between atypical metastases and tumor depth.CONCLUSION: Lower and larger tumors were more likely to have transversal metastases compared with others; however, skip metastases were less common in large tumors.
Adenocarcinoma ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Risk Factors ; Stomach Neoplasms