Background/Aims: Bacteria-derived outer membrane vesicles (OMVs) are commonly associated with various biological activities and functions. Helicobacter pylori-derived OMVs are thought to contribute to pathogenesis. This study aimed to investigate the effects of H. pylori-derived OMVs. Methods: H. pylori strains were isolated from patients with gastritis, gastric ulcer, or gastric cancer using endoscopic biopsy. The U-937, AGS, and MKN-45 cell lines were exposed to H. pylori and H. pylori-derived OMVs. The expression of interleukin 8 (IL-8) messenger RNA (mRNA) was assessed using reverse transcription-polymerase chain reaction (RT-PCR) and real-time RT-PCR, and IL-8 secretion was analyzed using enzyme-linked immunosorbent assay. Nuclear factor kappa B (NF-κB) activation was evaluated by Western blotting. Results: H. pylori and H. pylori-derived OMVs induced the expression of IL-8 mRNA and protein. Importantly, the bacteria induced higher IL-8 mRNA and protein expression than the OMVs. IL-8 expression was induced to different levels in response to H. pylori-derived OMVs from hosts with different gastric diseases. Western blotting revealed the increased phosphorylation and reduced degradation of inhibitor of NF-κB alpha in cells exposed to OMVs. Conclusions H. pylori-derived OMVs may aid the development of various gastric diseases by inducing IL-8 production and NF-κB activation.

Background/Aims: Bacteria-derived outer membrane vesicles (OMVs) are commonly associated with various biological activities and functions. Helicobacter pylori-derived OMVs are thought to contribute to pathogenesis. This study aimed to investigate the effects of H. pylori-derived OMVs. Methods: H. pylori strains were isolated from patients with gastritis, gastric ulcer, or gastric cancer using endoscopic biopsy. The U-937, AGS, and MKN-45 cell lines were exposed to H. pylori and H. pylori-derived OMVs. The expression of interleukin 8 (IL-8) messenger RNA (mRNA) was assessed using reverse transcription-polymerase chain reaction (RT-PCR) and real-time RT-PCR, and IL-8 secretion was analyzed using enzyme-linked immunosorbent assay. Nuclear factor kappa B (NF-κB) activation was evaluated by Western blotting. Results: H. pylori and H. pylori-derived OMVs induced the expression of IL-8 mRNA and protein. Importantly, the bacteria induced higher IL-8 mRNA and protein expression than the OMVs. IL-8 expression was induced to different levels in response to H. pylori-derived OMVs from hosts with different gastric diseases. Western blotting revealed the increased phosphorylation and reduced degradation of inhibitor of NF-κB alpha in cells exposed to OMVs. Conclusions H. pylori-derived OMVs may aid the development of various gastric diseases by inducing IL-8 production and NF-κB activation.

Anteromedial force to the knee in an extended position can cause an avulsion fracture of the proximal fibula with combined injuries to the posterolateral ligaments. Avulsion fractures of the proximal fibula are rare and current management of these fractures is based on few descriptions in literature. Various surgical methods of fixation for these fractures have been reported, but there is still no standard treatment modality. Anatomic reduction of these fractures is technically difficult, and failure of reduction may cause posterolateral instability, secondary arthritis and other complications. We present our experience with two such cases of comminuted avulsion fractures of the proximal fibular with posterolateral ligament ruptures surgically fixated with a locking compression hook plate and non absorbable sutures.
Arthritis ; Collateral Ligaments ; Fibula ; Knee ; Ligaments ; Rupture ; Sutures

Novel agents to treat multiple myeloma (MM) have increased complete respone (CR) rates compared with conventional chemotherapy, and the quality of the response to treatment has been correlated with survival. The purpose of our study was to show how of early response to bortezomib combined chemotherapy influences survival in patients with newly diagnosed MM who are ineligible for stem cell transplantation. We assessed patient responses to at least four cycles of bortezomib using the International Myeloma Working Group response criteria. The endpoints were comparisons of progression free survival (PFS) and overall survival (OS) between early good response group (A group) and poor response group (B group). We retrospectively analyzed data from 129 patients registered by the Korean Multiple Myeloma Working Party, a nationwide registration of MM patients. The 3 yr PFS for the A and B groups was 55.6% and 18.4%, respectively (P < 0.001). The 3 yr OS for the A and B groups was 65.3% and 52.9%, respectively (P = 0.078). The early response to at least four cycle of bortezomib before next chemotherapy may help predict PFS in patients with MM who are ineligible stem cell transplantation.
Aged ; Antineoplastic Agents/*therapeutic use ; Boronic Acids/*therapeutic use ; Disease-Free Survival ; drugs Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Multiple Myeloma/*drug therapy/mortality ; Predictive Value of Tests ; Pyrazines/*therapeutic use ; Registries ; Retrospective Studies ; *Stem Cell Transplantation ; Treatment Outcome

Biliary papillomatosis is a rare disease with a high risk of recurrence and malignant transformation. Therapeutic options include partial hepatectomy, Whipple's procedure and liver transplantation. If there is no surgical option left due to several reasons, local palliative procedures such as biliary stenting and drainage for the treatment of cholestasis are considered, but tumor growth cannot be influenced. Photodynamic therapy might be a new additional, palliative option for patients with biliary papillomatosis who are not eligible for surgery. Benign biliary stricture is a rare complication of photodynamic therapy. We report here a case of a 63-year-old male who developed benign biliary stricture after photodynamic therapy using the photosensitizer photofrin.
Cholestasis ; Constriction, Pathologic ; Dihematoporphyrin Ether ; Drainage ; Hepatectomy ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Papilloma ; Photochemotherapy ; Rare Diseases ; Recurrence ; Stents

PURPOSE: To evaluate the necessity for repair of associated deltoid ligament rupture in lateral malleolar fracture. MATERIALS AND METHODS: Twenty of twenty-five patients were evaluated. Each received surgical treatment without repair of the ruptured deltoid ligament. We found that the medial clear space was widened more than 5 mm in intraoperative stress tests which had been done between May 2003 and June 2008. We did follow-up on these patients for more than 1 year after surgery. At the final follow-up, radiologic and clinical assessment were evaluated on plain X-ray and according to Olerud Molander ankle scores. RESULTS: Open reduction and internal fixation of the lateral malleolar was done in all cases and an additional transfixation screw was needed in 17 patients who had concurrent syndesmotic disruption. Average medial clear space widening before surgery was 9.28 mm (7.0-17.14 mm), at final follow-up time it was 3.43 mm (2.9-5.28 mm). And there were 8 (40%) good, 10 (50%) fair and 2 (10%) poor ratings on radiologic evaluation, but the mean clinical score was 93.75, with 17 (85%) being excellent, 2 (10%) good and 1 (5%) fair on clinical evaluation. CONCLUSION: In the treatment of lateral malleolus fracture associated with disruption of the deltoid ligament, satisfactory clinical results could be obtained including lateral joint stability, with accurate anatomical reduction and internal fixation of the lateral malleolus and distal tibio-fibular joints. Medial joint stability could be obtained without deltoid ligament repair.
Animals ; Ankle ; Exercise Test ; Follow-Up Studies ; Humans ; Joints ; Ligaments ; Rupture

PURPOSE: To evaluate the clinical results after operative treatment with the double tension band wire fixation in Neer type II and III distal clavicle fractures. MATERIALS AND METHODS: Ten patients with type II and III distal clavicle fractures were evaluated, who operated with double tension band wire fixation technique, from Febrary 2007 to June 2008, and could be followed-up for more than 1 year after operation. Postoperative assessments were evaluated on plain x-ray, pain, and clinical finding according to the functional criteria by Kona et al. RESULTS: Average duration from operation to fracture union was 8 weeks in all cases. There were 8 excellent and 2 good results. It was no other significant complications such as K-wire migration, breakage, infection, and AC joint arthritis. CONCLUSION: Double tension band wire fixation technique seems to be an effective method for type II or III distal clavicle fracture with multiple compressive axis, without injury of the AC joint and loosening of the fixation.
Axis, Cervical Vertebra ; Clavicle ; Humans ; Joints

PURPOSE: Although methylxanthines (aminophylline or theophylline) have an equivalent bronchodilator effect on inhaled beta2-agonists, the GINA guidelines recommend methylxanthines as an alternative to methylxanthines becamse of their side effects. The Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGTMA 2005), however, recommends methylxanthines for the treatment of asthma attack along with systemic corticosteroids. We aimed to determine whether the addition of intravenous (IV) aminophylline with both IV corticosteroids and inhaled beta2-agonists would improve asthma symptoms better and earlier without serious adverse effects. METHODS: Thirty-seven children with acute asthma exacerbation were studied. Twenty patients were treated with a combination of IV corticosteroids, inhaled beta2 agonists and IV aminophyllines (Group A), and 17 patients were treated with IV corticosteroids and inhaled beta2 agonists only (Group B). We evaluated the changes of symptom scores, including degrees of wheezing, retraction, orthopnea, cyanosis and SpO2, before and after treatment in both groups. RESULTS: Group A patients showed faster improvement in asthma symptom score (P<0.05) and significantly faster resolution of wheezing (P<0.05) than Group B patients. In Group B, patients with prolonged wheezing (>72 hours) resulted in need for larger dose of systemic steroids (P<0.05). Although adverse effects occurred in 20% of Group A patients, all of which them were not serious without the need for drug withdrawal. CONCLUSION: IV aminophylline may be a therapeutic option for children with acute asthma exacerbation. Further evidence is needed to substantiate the conclusion.
Adrenal Cortex Hormones ; Aminophylline* ; Asian Continental Ancestry Group ; Asthma* ; Bronchodilator Agents ; Child* ; Cyanosis ; Humans ; Respiratory Sounds ; Steroids

PURPOSE: The evaluation of clinical skills and attitudes is an essential component of any examination assessing clinical competency. Objective structured clinical examination (OSCE) was introduced in the 1980's to medical educators for the objective evaluation of clinical competency. In this study, the authors describe and analyse their experience with developing and implementing the OSCE for the board licensure examination of plastic surgeons in Korea. METHODS: We developed a 50-minute long OSCE consisting of ten 5-minute (4.5 minute for examination at each station and 0.5 minute for transfer) stations, duplicated. We divided 74 applicants into 8 groups (about 10 applicants per group). Four stations out of the ten in each station-set used a standardized patient (SP). We compared the scores of the duplicated station-sets to assess the reliability of scoring between station-sets. And we analysed the applicants' questionnaire survey feedbacks on this experience administered at the end of the examination. RESULTS: The passing rate of the examination was 100%. The total scores were statistically different between the two station-sets. Applicants were satisfied with the examination, and felt that the problem-solving processes adopted in each station were valid and appropriate for the assessment of clinical competency for board licensure examination. CONCLUSION: We conclude that the OSCE can be widely applied to board licensure examinations of various specialties.
Clinical Competence ; Humans ; Korea ; Licensure* ; Surveys and Questionnaires

PURPOSE: To evaluate the clinical outcomes and radiographic results of operative treatment for intraarticular calcaneal fracture. MATERIALS AND METHODS: We reviewed 57 cases of intraarticular calcaneal fracture managed with operative treatment, from January, 2000 to June, 2003. The type of intraarticular calcaneal fracture is classified by the Essex-Lopresti classification and Sanders by computed tomography. The 20 cases were managed by open reduction, 37 cases by closed reduction. RESULTS: On clinical outcomes in the case of open reduction and internal fixation, above good in 13 cases, poor in 2 cases; closed reduction, above good in 16 cases, poor in 10 cases. Averages of Bohler angle were increased from 11degrees (preoperative state) to 21degrees (last follow up) in open reduction, and from 14degrees to 20.9degrees in closed reduction. CONCLUSION: Open reduction was considered to be one of good treatment option if the anatomical reduction and stable fixation can be obtained.
Classification ; Intra-Articular Fractures