It has been reported that stressful events in early life influence behavior in adulthood and are associated with different psychiatric disorders, such as major depression, post-traumatic stress disorder, bipolar disorder, and anxiety disorder.Maternal separation (MS) is a representative animal model for reproducing childhood stress. It is used as an animal model for depression, and has well-known effects, such as increasing anxiety behavior and causing abnormalities in the hypothalamicpituitary-adrenal (HPA) axis. This study investigated the effect of MS on anxiety or aggression-like behavior and the number of GABAergic neurons in the hippocampus. Mice were separated from their dams for four hours per day for 19 d from postnatal day two. Elevated plus maze (EPM) test, resident-intruder (RI) test, and counted glutamic acid decarboxylase 67 (GAD67) or parvalbumin (PV) positive cells in the hippocampus were executed using immunohistochemistry. The maternal segregation group exhibited increased anxiety and aggression in the EPM test and the RI test. GAD67-positive neurons were increased in the hippocampal regions we observed:dentate gyrus (DG), CA3, CA1, subiculum, presubiculum, and parasubiculum. PVpositive neurons were increased in the DG, CA3, presubiculum, and parasubiculum.Consistent with behavioral changes, corticosterone was increased in the MS group, suggesting that the behavioral changes induced by MS were expressed through the effect on the HPA axis. Altogether, MS alters anxiety and aggression levels, possibly through alteration of cytoarchitecture and output of the ventral hippocampus that induces the dysfunction of the HPA axis.

BACKGROUND/AIMS: To use serological and multiplex polymerase chain reaction (PCR) assays to examine sputum samples from patients experiencing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) for the presence of atypical pathogens, including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. METHODS: From September 2012 to February 2014, 341 patients with AECOPD attending outpatient clinics were enrolled as part of a randomized, double-blind, multicenter study. A commercial enzyme-linked immunosorbent assay was used to measure serum immunoglobulin M (IgM) and IgG antibody titers on the first day of the study and at 36 days post-enrollment. Multiplex PCR was used to test sputum samples for the presence of atypical pathogens. A urinary antigen test for L. pneumophila was performed on the first day. RESULTS: Nineteen patients (5.6%) showed serological evidence of acute infection with M. pneumoniae. Also, one and seven patients (2%) showed serological evidence of acute infection with C. pneumoniae and L. pneumophila, respectively. All DNA samples were negative for M. pneumoniae, C. pneumoniae, and L. pneumophila according to PCR. Only one urine sample was positive for L. pneumophila antigen, but serologic evidence was lacking. CONCLUSIONS: Serological testing suggested that infection by atypical pathogens during AECOPD was relatively uncommon. In addition, PCR provided no direct evidence of infection by atypical pathogens. Thus, atypical pathogens may not be a major cause of AECOPD in South Korea.
Ambulatory Care Facilities ; Chlamydophila pneumoniae ; DNA ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Legionella pneumophila ; Multiplex Polymerase Chain Reaction ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction* ; Pulmonary Disease, Chronic Obstructive* ; Serologic Tests ; Sputum

BACKGROUND: Lung cancer is the most common cause of cancer-related death worldwide and in Korea, and small cell lung cancer (SCLC) is the most deadly tumor type in the different lung cancer histology. Chemotherapy is the main strategy of the treatment for SCLC, and etoposide and platinum regimen has been the only standard chemotherapy for about 30 years. To test feasibility of weekly divided dose irinotecan and carboplatin for Korean patients is the aim of this study. METHODS: Patients with histologically or cytologically confirmed extensive stage SCLC were included. Patients with limited stage (LD), who could not tolerate concurrent chemoradiotherapy were also included. All the patients received irinotecan 60 mg/m2, carboplatin 2 area under the curve at day 1, 8, and 15 every 4 weeks. Study regimen was discontinued when the disease progressed or intolerable side effects occurred. No more than 6 cycles of chemotherapy were given. RESULTS: Total 47 patients were enrolled, among them 9 patients were LD. Overall response rate was 74.5% (complete response, 14.9%; partial response, 59.6%). Side effects greater than grade 3 were neutropenia (25.5%), fatigue (12.8%), thrombocytopenia (8.5%), sepsis (4.3%), and pancytopenia (2.1%). There was no treatment related death. CONCLUSION: Weekly divided irinotecan and carboplatin regimen is effective, and safe as a first line therapy for both stage of SCLC. Large scaled, controlled study is feasible.
Carboplatin* ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Etoposide ; Fatigue ; Humans ; Korea ; Lung Neoplasms ; Neutropenia ; Pancytopenia ; Platinum ; Sepsis ; Small Cell Lung Carcinoma* ; Thrombocytopenia

A 27-year-old male with nonobstructive hydronephrosis was referred from the urology department for polyuria evaluation and management. The patient was hospitalized for urinary tract infection and cystostomy was performed due to neurogenic bladder of unknown origin. The patient was of short stature and had visual impairment. From the interview, we discovered he had been suffering from polyuria and polydipsia for more than 20 years. Urine output was 13 L/day and urine osmolarity was 85 mOsm/kg. The results of a water deprivation test were consistent with central diabetes insipidus. Septo-optic dysplasia (SOD) was observed on brain magnetic resonance imaging (MRI). SOD is a very rare condition characterized by agenesis of the septum pellucidum or corpus callosum, which may cause optic nerve aplasia or hypoplasia, midbrain abnormalities and/or hypopituitarism. After desmopressin treatment, polyuria and hydronephrosis were improved. We report a case of a 27-year-old male diagnosed with SOD including diabetes insipidus, resulting in nonobstructive hydronephrosis.
Adult ; Brain ; Corpus Callosum ; Cystostomy ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Diabetes Insipidus, Neurogenic* ; Humans ; Hydronephrosis* ; Hypopituitarism ; Magnetic Resonance Imaging ; Male ; Mesencephalon ; Optic Nerve ; Osmolar Concentration ; Polydipsia ; Polyuria ; Septo-Optic Dysplasia* ; Septum Pellucidum ; Urinary Bladder, Neurogenic ; Urinary Tract Infections ; Urology ; Vision Disorders ; Water Deprivation

BACKGROUND: Catheter-related exit site infection is a major risk factor for the development of peritonitis and can contribute to failure of treatment maintenance in peritoneal dialysis (PD) patients. Although povidone-iodine can be used for exit site care, the irritation induced by the local application of povidone-iodine could lead to secondary infection. Therefore, we evaluated the clinical effectiveness of normal saline compared with povidone-iodine as a method of exit site care in chronic PD patients. METHODS: In all, 126 patients undergoing PD treatment for>46 months between January 2006 and December 2009 were enrolled. Data were retrospectively analyzed for the incidence of exit site infection and peritonitis for 2 years prior to and after December 2007. In addition, we identified the incidences of catheter- related infections during follow-ups from January 2010 to December 2013. RESULTS: The participants' mean age was 58.87+/-12.9 years. The incidences of exit site infection and peritonitis were one episode per 64.6 patients-months and one episode per 40.4 patients-months in the povidone-iodine group, respectively, whereas these were one episode per 57.5 patients-months and one episode per 45.6 patients-months in the normal saline group, respectively. Whereas Gram-positive bacteria most frequently caused catheter-related infections in both groups, culture-negative infections were dominant in the normal saline group. CONCLUSION: Exit site care using normal saline did not increase the incidence of exit site infection and peritonitis. Therefore, normal saline may be an alternative treatment for exit site care in patients receiving PD.
Catheter-Related Infections ; Coinfection ; Follow-Up Studies ; Gram-Positive Bacteria ; Humans ; Incidence* ; Peritoneal Dialysis* ; Peritonitis* ; Povidone-Iodine* ; Retrospective Studies ; Risk Factors

We present a 17-year-old man who underwent brain magnetic resonance imaging and laboratory exams for uncontrolled seizure. Patients with an autistic disorder require deep sedation or, occasionally, general anesthesia even for radiologic exams or simple procedures. The anesthetic management of an obese, violent patient with a severe autistic disorder and mental retardation can be challenging to anesthesiologists and requires a more careful approach in selecting adequate anesthetics and doses. This case emphasizes the importance of having a detailed plan to ensure the smooth process of premedication, anesthetic induction, maintenance, emergence and safe discharge of incorporated patients in the event of unexpected situations. A 5% lidocaine patch to relieve the pain from the intramuscular injection and intravenous cannulation, intramuscular midazolam as premedication, and propofol for the maintenance of sedation can be a good sedation protocol in incorporated patients.
Adolescent* ; Anesthesia, General ; Anesthetics ; Animals ; Autistic Disorder* ; Brain* ; Catheterization ; Comb and Wattles* ; Deep Sedation ; Humans ; Injections, Intramuscular ; Intellectual Disability ; Lidocaine* ; Magnetic Resonance Imaging* ; Midazolam* ; Obesity ; Premedication ; Propofol* ; Seizures

BACKGROUND: Intravenous administration of rocuronium induces intense pain in most patients (60-100%). This could be harmful during anesthesia induction because of the unintended reflex movement of an unconscious patient in response to the pain. Previous studies have reported that remifentanil effectively reduces rocuronium-induced pain and withdrawal movements. This study was designed to evaluate the EC50 and EC95 of remifentanil to prevent withdrawal movements in children. METHODS: We enrolled a total of 171 pediatric patients scheduled for general anesthesia in this study. Remifentanil was administrated by target-controlled infusion. Effect-site target concentrations ranged from 0.5 to 3.0 ng/ml. At each concentration, experiments were repeated in 10-20 patients. Propofol 2 mg/kg and rocuronium 0.9 mg/kg were administrated after equilibration of plasma and effect-site target remifentanil concentration. The withdrawal movements were graded on a 4-point scale. The EC50 and EC95 of remifentanil to prevent rocuronium-induced withdrawal movements were determined by using a logistic regression model. RESULTS: The logistic regression model showed that the probability of preventing rocuronium-induced withdrawal movement was as follows: exp (-3.49 + 2.07 x remifentanil concentration) / (1 + exp [-3.49 + 2.07 x remifentanil concentration]). EC50 and EC95 were 1.69 ng/ml (95% confidence intervals [CIs], 1.42-1.87) and 3.11 ng/ml (95% CIs, 2.79-3.72), respectively. CONCLUSIONS: Administration of remifentanil at an effect-site target concentration of 3.1 ng/ml could effectively prevent rocuronium-induced withdrawal movements.
Administration, Intravenous ; Anesthesia ; Anesthesia, General ; Child* ; Humans ; Logistic Models ; Pediatrics ; Plasma ; Propofol ; Reflex

Umbilical cord blood is an attractive source of hematopoietic stem cells in allogeneic hematopoietic stem cell transplantation. Umbilical cord blood transplantation has merits of rapid availability and low risk of severe acute graft versus host disease. Umbilical cord blood should be an important source of stem cell transplantation for patients who have no suitable human leukocyte antigen-matched bone marrow, or peripheral stem cell donor. Transplantation of umbilical cord blood is limited by insufficient cell doses. This had led to the alternative concept of attempting to increase the number of cell doses using two cord blood units from different donor. We report a case of double-unit cord blood transplantation for 55-year-old male with primary refractory acute myeloid leukemia.
Bone Marrow ; Fetal Blood* ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukemia, Myeloid, Acute* ; Leukocytes ; Male ; Middle Aged ; Stem Cell Transplantation ; Stem Cells ; Tissue Donors

BACKGROUND: Postoperative nausea and vomiting (PONV) commonly occur after general anesthesia, especially in women. In this study, we evaluated the antiemetic efficacy of propofol administered at the end of surgery in highly susceptible patients undergoing a laparoscopy-assisted vaginal hysterectomy. METHODS: A total of 107 women undergoing a laparoscopy-assisted vaginal hysterectomy under general anesthesia were enrolled for this prospective, double-blind, randomized study. Fifteen minutes before the end of surgery, all patients received 50 microg fentanyl and 1 of following 3 doses; 0.5 mg/kg of propofol (propofol 0.5 group), 1 mg/kg of propofol (propofol 1.0 group), and normal saline (control group). All patients received intravenous patient-controlled analgesia (PCA). Emergence time, a visual analog scale for pain and nausea, duration of postanesthesia care unit (PACU) stay, and frequency of antiemetic use were recorded at 0-2, 2-24, and 24-48 hours postoperatively. RESULTS: The incidence of nausea significantly lower in the propofol 0.5 and propofol 1.0 groups than in the control group (12.1 vs 14.7 vs 40%). During the first postoperative 2 hours, antiemetics were less frequently administered in the propofol 0.5 and propofol 1.0 groups than in the control group (3.0 vs 5.9 vs 22.5%). Emergence time was slightly longer in the propofol 0.5 and propofol 1.0 groups than in the control group, but there was no significant difference in PACU stay time was observed between the 3 groups. CONCLUSIONS: The results of this study suggest that low-dose propofol administration at the end of surgery may effectively reduce the incidence of PONV within 2 hours postoperatively in highly susceptible women undergoing a laparoscopiy-assisted vaginal hysterectomy and receiving opioid-based PCA.
Analgesia, Patient-Controlled ; Anesthesia, General ; Antiemetics* ; Female ; Fentanyl ; Humans ; Hysterectomy, Vaginal* ; Incidence ; Laparoscopy ; Nausea ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Propofol* ; Prospective Studies ; Visual Analog Scale

The differential diagnosis of cardiac mass is important in determining the therapeutic plan and avoiding unnecessary surgical intervention. Non-invasive imaging methods would be useful in the diagnosis of suspected cardiac mass, because they may provide earlier diagnosis and more accurate assessment of cardiac mass. Native aortic valve thrombosis is a rare disorder and difficult to differentiate from a tumor, and in particular, a papillary fibroelastoma. Thus, the clinical decision making with imaging modalities should be performed cautiously. We recently met a female patient who had a aortic valve mass resembling papillary fibroelastoma in normal native valve. The patient underwent a surgical resection and the pathologic finding showed an organized thrombus with no evidence of papillary fibroelastoma.
Aortic Valve* ; Decision Making ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Pulmonary Embolism ; Thrombosis*