Background: Intraoperative hemoglobin (Hb) monitoring is critical for ensuring patient safety during bimaxillary orthognathic surgery. Intraoperative Hb monitoring performed using portable devices with arterial blood samples is invasive, is time-consuming, and lacks the ability to provide real-time information. This retrospective study investigated the correlation between continuous and real-time total Hb (SpHb) using a Masimo Radical 7 device and Hb levels derived by portable devices during bimaxillary orthognathic surgery. Methods: Patients who underwent elective bimaxillary orthognathic surgery were enrolled. The correlation between SpHb and laboratory Hb (Lab-Hb) was evaluated immediately after the induction of anesthesia (T1) and at surgical closure (T2) and compared with postoperative Hb. Results: Eighty-eight patients were included. The correlation coefficients between SpHb and Lab-Hb were 0.795 and 0.859 at T1 and T2, respectively. The correlation coefficient between Lab-Hb at T2 and postoperative Hb was 0.918. A Bland-Altman analysis of the Lab-Hb at T2 and postoperative Hb showed a mean bias of 0.49. Conclusion In conclusion, here we demonstrated acceptable accuracy of the SpHb measured by the Masimo Radical 7 device during bimaxillary orthognathic surgery. However, SpHb is valuable as an adjunct value to Lab-Hb and a substitute for Hb monitoring due to its wide limits of agreement. These findings suggest that SpHb can help guide the timing of invasive blood sampling for Hb measurements, which may facilitate earlier intervention and treatment.

Background: Intraoperative hemoglobin (Hb) monitoring is critical for ensuring patient safety during bimaxillary orthognathic surgery. Intraoperative Hb monitoring performed using portable devices with arterial blood samples is invasive, is time-consuming, and lacks the ability to provide real-time information. This retrospective study investigated the correlation between continuous and real-time total Hb (SpHb) using a Masimo Radical 7 device and Hb levels derived by portable devices during bimaxillary orthognathic surgery. Methods: Patients who underwent elective bimaxillary orthognathic surgery were enrolled. The correlation between SpHb and laboratory Hb (Lab-Hb) was evaluated immediately after the induction of anesthesia (T1) and at surgical closure (T2) and compared with postoperative Hb. Results: Eighty-eight patients were included. The correlation coefficients between SpHb and Lab-Hb were 0.795 and 0.859 at T1 and T2, respectively. The correlation coefficient between Lab-Hb at T2 and postoperative Hb was 0.918. A Bland-Altman analysis of the Lab-Hb at T2 and postoperative Hb showed a mean bias of 0.49. Conclusion In conclusion, here we demonstrated acceptable accuracy of the SpHb measured by the Masimo Radical 7 device during bimaxillary orthognathic surgery. However, SpHb is valuable as an adjunct value to Lab-Hb and a substitute for Hb monitoring due to its wide limits of agreement. These findings suggest that SpHb can help guide the timing of invasive blood sampling for Hb measurements, which may facilitate earlier intervention and treatment.

Background: Intraoperative hemoglobin (Hb) monitoring is critical for ensuring patient safety during bimaxillary orthognathic surgery. Intraoperative Hb monitoring performed using portable devices with arterial blood samples is invasive, is time-consuming, and lacks the ability to provide real-time information. This retrospective study investigated the correlation between continuous and real-time total Hb (SpHb) using a Masimo Radical 7 device and Hb levels derived by portable devices during bimaxillary orthognathic surgery. Methods: Patients who underwent elective bimaxillary orthognathic surgery were enrolled. The correlation between SpHb and laboratory Hb (Lab-Hb) was evaluated immediately after the induction of anesthesia (T1) and at surgical closure (T2) and compared with postoperative Hb. Results: Eighty-eight patients were included. The correlation coefficients between SpHb and Lab-Hb were 0.795 and 0.859 at T1 and T2, respectively. The correlation coefficient between Lab-Hb at T2 and postoperative Hb was 0.918. A Bland-Altman analysis of the Lab-Hb at T2 and postoperative Hb showed a mean bias of 0.49. Conclusion In conclusion, here we demonstrated acceptable accuracy of the SpHb measured by the Masimo Radical 7 device during bimaxillary orthognathic surgery. However, SpHb is valuable as an adjunct value to Lab-Hb and a substitute for Hb monitoring due to its wide limits of agreement. These findings suggest that SpHb can help guide the timing of invasive blood sampling for Hb measurements, which may facilitate earlier intervention and treatment.

Immune status including the immune cells and cytokine profiles has been implicated in the development of endometriosis. In this study, we analyzed Th17 cells and IL-17A in peritoneal fluid (PF) and endometrial tissues of patients with (n=10) and without (n=26) endometriosis. Our study has shown increased Th17 cell population and IL-17A level in PF with endometriosis patients. To determine the roles of IL-17A and Th17 cells in the development of endometriosis, the effect of IL-17A, major cytokine of Th17, on endometrial cells isolated from endometriotic tissues was examined. Recombinant IL-17A promoted survival of endometrial cells accompanied by increased expression of anti-apoptotic genes, including Bcl-2 and MCL1, and the activation of ERK1/2 signaling. In addition, treatment of IL-17A to endometrial cells inhibited NK cell mediated cytotoxicity and induced HLA-G expression on endometrial cells. IL-17A also promoted migration of endometrial cells. Our data suggest that Th17 cells and IL-17A play critical roles in the development of endometriosis by promoting endometrial cell survival and conferring a resistance to NK cell cytotoxicity through the activation of ERK1/2 signaling. Targeting IL-17A has potential as a new strategy for the treatment of endometriosis.

BACKGROUND/AIMS: Colorectal cancer is associated with different anatomical, biological, and clinical characteristics. We determined the impact of the primary tumor location in patients with metastatic colorectal cancer (mCRC). METHODS: Demographic data and clinical information were collected from 1,115 patients from the Republic of Korea, who presented with mCRC between January 2009 and December 2011, using web-based electronic case report forms. Associations between the primary tumor location and the patient's clinical characteristics were assessed, and factors inf luencing overall survival were analyzed using Cox proportional hazards regression models. RESULTS: Of the 1,115 patients recruited to the study, 244 (21.9%) had right colon cancer, 483 (43.3%) had left colon cancer, and 388 (34.8%) had rectal cancer. Liver and lung metastases occurred more frequently in patients with left colon and rectal cancer (p = 0.005 and p = 0.006, respectively), while peritoneal and ovarian metastases occurred more frequently in patients with right and left colon cancer (p < 0.001 and p = 0.031, respectively). The median overall survival of patients with tumors originating in the right colon was significantly shorter than that of patients whose tumors had originated in the left colon or rectum (13.7 months [95% confidence interval (CI), 12.0 to 15.5] vs. 18.0 months [95% CI, 16.3 to 19.7] or 19.9 months [95% CI, 18.5 to 21.3], respectively; p = 0.003). Tumor resection, the number of metastatic sites, and primary tumor location correlated with overall survival in the univariate and multivariate analyses. CONCLUSIONS: Primary tumor location influences the metastatic sites and prognosis of patients with mCRC.
Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Humans ; Liver ; Lung ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms ; Rectum ; Republic of Korea

PURPOSE: Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. Nutrition risk screening aims to increase awareness and allow early recognition and treatment of cancer cachexia. Therefore, screenings should be brief, inexpensive, highly sensitive, and have good specificity. Simplified Nutritional Appetite Questionnaire (SNAQ) is a simple screening tool including four questions, and validated to predict weight loss within 6 months in community-dwelling adults and nursing home residents. Our study aimed to translate the SNAQ into Korean, and to assess the validity and reliability of the translated screening tool in advanced cancer patients. MATERIALS AND METHODS: The SNAQ was translated into Korean according to linguistic validation. The internal consistency of the SNAQ was evaluated by Cronbach's alpha coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient. Concurrent validity was evaluated by measuring the Pearson's correlation coefficient between the SNAQ and Mini-Nutritional Assessment (MNA) and Patient-Generated Subjective Global Assessment (PG-SGA). RESULTS: In the 194 patients included in full analysis set, cancer stage was predominantly metastatic (98.5%), the mean age was 60 years (range, 23 to 81 years), and the mean body mass index was 24 kg/m² (range, 15.6 to 39.6 kg/m²). According to MNA score ≤ 11, 57 patients (29.4%) were malnourished. The mean score (±standard deviation) of the Korean version of the SNAQ was 13.8±2.5 with a range of 6-19. Cronbach's alpha coefficient was 0.737, and intraclass correlation coefficient was 0.869. The SNAQ was moderately correlated with MNA (r=0.404, p < 0.001) and PG-SGA (r=–0.530, p < 0.001). A significant weight loss of > 5% of the original bodyweightwithin 6 months occurred in 46 of the 186 patients (24.7%). SNAQ score ≤ 14 predicted > 5% weight loss with a sensitivity of 56.5% and a specificity of 44.3%. CONCLUSION: The Korean version of the SNAQ had high validity and reliability. SNAQ is useful for the screening tool for advanced cancer patients. The SNAQ had a limitation to predict impending weight loss in advanced cancer patients.
Adult ; Appetite ; Body Mass Index ; Cachexia ; Humans ; Linguistics ; Longitudinal Studies ; Malnutrition ; Mass Screening ; Nursing Homes ; Nutrition Assessment ; Reproducibility of Results ; Sensitivity and Specificity ; Weight Loss

Cirsium japonicum belongs to the Asteraceae or Compositae family and is a medicinal plant in Asia that has a variety of effects, including tumour inhibition, improved immunity with flavones, and antidiabetic and hepatoprotective effects. Silymarin is synthesized by 4-coumaroyl-CoA via both the flavonoid and phenylpropanoid pathways to produce the immediate precursors taxifolin and coniferyl alcohol. Then, the oxidative radicalization of taxifolin and coniferyl alcohol produces silymarin. We identified the expression of genes related to the synthesis of silymarin in C. japonicum in three different tissues, namely, flowers, leaves, and roots, through RNA sequencing. We obtained 51,133 unigenes from transcriptome sequencing by de novo assembly using Trinity v2.1.1, TransDecoder v2.0.1, and CD-HIT v4.6 software. The differentially expressed gene analysis revealed that the expression of genes related to the flavonoid pathway was higher in the flowers, whereas the phenylpropanoid pathway was more highly expressed in the roots. In this study, we established a global transcriptome dataset for C. japonicum. The data shall not only be useful to focus more deeply on the genes related to product medicinal metabolite including flavolignan but also to study the functional genomics for genetic engineering of C. japonicum.
Asia ; Asteraceae ; Cirsium ; Dataset ; Estrone ; Flavones ; Flowers ; Gene Expression Profiling ; Genetic Engineering ; Genomics ; Humans ; Plants, Medicinal ; Sequence Analysis, RNA ; Silymarin ; Transcriptome

BACKGROUND: The shortage of human hearts for allotransplantation makes xenotransplantation a possible option for controllable organ providers. To detect acute xenograft rejection, invasive biopsy seems inevitable; however, this occasionally results in poor incision wound healing or infection. To date, no method of noninvasive imaging for early detection of xenograft rejection has been established. We hypothesized that ultrasound speckle tracking would better detect xenograft failure than routine left ventricular ejection fractions (EF). METHODS: From August 2013 to July 2015, a total of six cardiac heterotopic xenotransplants (α 1, 3-galactosyltransferase gene-knockout porcine heart) into cynomolgus monkeys were monitored with echocardiography every 3 to 7 days. M-mode and two-dimensional (2D)-EF measurements and myocardial strain analyses were performed. Cardiac xenograft pathology was reviewed from the immediate postoperative biopsy, as well as the necropsy. RESULTS: Myocardial speckle tracking analysis was feasible in all six cases. The longest survival was 43 days. Only one pathology-proven immunologic rejection occurred. Cardiac xenograft failure appeared as two types: a dilated pattern with decreased EF or a myocardial-thickening pattern with preserved EF. Both antibody-mediated rejection (n=1) and sepsis-induced myocardial dysfunction (n=2) revealed decreased radial or circumferential strains, but normal-range EF. Xenograft functional decline was significant with respect to radial or circumferential strain (P=0.028), but not to conventional M-mode or 2D-EFs (P=0.600, P=0.340, respectively). CONCLUSIONS: Radial and circumferential strains were significantly decreased in both types of xenograft failure, regardless of EF. Further studies are warranted to correlate the strain analysis and immunopathological details.
Biopsy ; Echocardiography ; Heart ; Heart Transplantation ; Heterografts ; Humans ; Macaca fascicularis ; Methods ; Pathology ; Stroke Volume ; Transplantation, Heterologous* ; Transplants* ; Ultrasonography ; Wound Healing

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.
Colon ; Colon, Sigmoid ; Colonoscopy ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

Autochthonous hepatitis E virus (HEV) is an emerging pathogen in developed countries, and several cases of acute HEV infection have been reported in South Korea. However, there have been no reports on HEV-associated Guillain-Barré syndrome (GBS) in Korea. We recently experienced the case of a 58-year-old Korean male with acute HEV infection after ingesting raw deer meat. Persistent cholestasis was resolved by the administration of prednisolone. At 2.5 months after the clinical presentation of HEV infection, the patient developed weakness of the lower limbs, and was diagnosed with GBS associated with acute hepatitis E. To our knowledge, this is the second report on supportive steroid therapy for persistent cholestasis due to hepatitis E, and the first report of GBS in a Korean patient with acute HEV infection.
Acute Disease ; Alanine Transaminase/blood ; Antibodies, Viral/blood ; Aspartate Aminotransferases/blood ; Bilirubin/analysis ; Cholestasis/*drug therapy ; Guillain-Barre Syndrome/complications/*diagnosis ; Hepatitis E/*diagnosis/etiology ; Hepatitis E virus/immunology ; Humans ; Immunoglobulin M/blood ; Liver/pathology ; Male ; Middle Aged ; Prednisolone/therapeutic use ; Republic of Korea ; Steroids/*therapeutic use