Purpose: Although metformin and sildenafil can protect various organs against ischemia/reperfusion (I/R) injuries, their effects and mechanisms of action in bladder I/R injuries remain unknown. This study investigated the effects and mechanisms of action of metformin and sildenafil against bladder I/R insults in rats. Methods: One hundred male Sprague-Dawley rats were randomly divided into 5 groups, each of which contained 20 rats: a sham-operated group, a bladder I/R group, and bladder I/R groups treated with metformin, sildenafil, or both agents. Ischemia was induced by clamping the bilateral common iliac arteries with atraumatic vascular clamps for 2 hours, followed by reperfusion for 7 days. During this period, rats were injected once daily with 4-mg/kg metformin and/or 1-mg/kg sildenafil. Results: I/R injuries induced increased malondialdehyde levels and myeloperoxidase activity and decreased superoxide dismutase activity. These changes were attenuated by treatment with metformin and/or sildenafil. The I/R group had significantly higher Jun N-terminal kinase, p38 mitogen-activated protein kinase (MAPK), Bax, caspase-3, and nuclear factor-kappa B (NF-κB) levels, and lower extracellular signal-regulated kinase, and Bcl-2 levels in the bladder than the sham-operated group; these changes were significantly ameliorated by metformin and/or sildenafil treatment. No differences in the levels of these markers were observed between rats coadministered metformin and sildenafil and those treated with either agent alone. Conclusions Metformin and sildenafil protected the rat bladder against I/R injuries. This effect may have been due to the inhibition of reactive oxygen species production through MAPK, Bax, and Bcl-2 activation, and the restoration of inflammation through NF-κB inhibition. However, the combination of metformin and sildenafil was not more effective than either agent alone.

Purpose: Targeted next-generation sequencing (NGS) panels for solid tumors have been useful in clinical framework for accurate tumor diagnosis and identifying essential molecular aberrations. However, most cancer panels have been designed to address a wide spectrum of pan-cancer models, lacking integral prognostic markers that are highly specific to gliomas. Materials and Methods: To address such challenges, we have developed a glioma-specific NGS panel, termed “GliomaSCAN,” that is capable of capturing single nucleotide variations and insertion/deletion, copy number variation, and selected promoter mutations and structural variations that cover a subset of intron regions in 232 essential glioma-associated genes. We confirmed clinical concordance rate using pairwise comparison of the identified variants from whole exome sequencing (WES), immunohistochemical analysis, and fluorescence in situ hybridization. Results: Our panel demonstrated high sensitivity in detecting potential genomic variants that were present in the standard materials. To ensure the accuracy of our targeted sequencing panel, we compared our targeted panel to WES. The comparison results demonstrated a high correlation. Furthermore, we evaluated clinical utility of our panel in 46 glioma patients to assess the detection capacity of potential actionable mutations. Thirty-two patients harbored at least one recurrent somatic mutation in clinically actionable gene. Conclusion We have established a glioma-specific cancer panel. GliomaSCAN highly excelled in capturing somatic variations in terms of both sensitivity and specificity and provided potential clinical implication in facilitating genome-based clinical trials. Our results could provide conceptual advance towards improving the response of genomically guided molecularly targeted therapy in glioma patients.

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered “taking as prescribed” was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was “Easy” or “Very easy” to use (P < 0.001). “Method of administration” was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., “Frequency of administration”). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.
Asthma ; Caregivers ; Child ; Delivery of Health Care ; Humans ; Hypersensitivity ; Korea ; Medication Adherence ; Transdermal Patch

Although Dieulafoy lesion can occur in any part of the gastrointestinal tract, its occurrence in the rectum is rare. Rectal Dieulafoy lesions have been associated with advanced age, renal failure, burns, liver transplantation and cirrhosis. Here, we report on a case of massive bleeding from a rectal Dieulafoy lesion after lung decortication surgery in a 57-year-old male patient with alcoholic cirrhosis. Although rare, a rectal Dieulafoy lesion should be included in the differential diagnosis of massive lower gastrointestinal bleeding in a patient with cirrhosis.
Alcoholics* ; Burns ; Diagnosis, Differential ; Fibrosis ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic* ; Liver Transplantation ; Lung ; Male ; Middle Aged ; Rectum ; Renal Insufficiency

Although Dieulafoy lesion can occur in any part of the gastrointestinal tract, its occurrence in the rectum is rare. Rectal Dieulafoy lesions have been associated with advanced age, renal failure, burns, liver transplantation and cirrhosis. Here, we report on a case of massive bleeding from a rectal Dieulafoy lesion after lung decortication surgery in a 57-year-old male patient with alcoholic cirrhosis. Although rare, a rectal Dieulafoy lesion should be included in the differential diagnosis of massive lower gastrointestinal bleeding in a patient with cirrhosis.
Alcoholics ; Burns ; Diagnosis, Differential ; Fibrosis ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic ; Liver Transplantation ; Lung ; Male ; Middle Aged ; Rectum ; Renal Insufficiency

Rheumatoid meningoencephalitis is a rare, but severe complication of rheumatoid arthritis (RA). A 64-year-old woman with the history of RA presented with abnormal behaviors and memory impairments since stopping methotrexate due to asymptomatic meningitis before 1 month. Brain MRI still demonstrated leptomeningeal enhancement in right fronto-temporal area, compared with the previous. Brain biopsy revealed multiple yellowish suppurative streaks in dura, and microscopically lymphoplasmic infiltrations and fibroid necrosis surrounded by granuloma. Soon after beginning treatment with corticosteroid and methotrexate, her symptoms improved.
Arthritis, Rheumatoid ; Biopsy ; Brain ; Female ; Granuloma ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Memory ; Meningitis ; Meningoencephalitis* ; Methotrexate* ; Middle Aged ; Necrosis

Patients with cervical spine instability and limited range of motion are challenge to anesthesiologists. It is important to consider alternatetive methods for securing the airway while maintaining neutral position and minimizing neck motion, because these patients are at increased risk for tracheal intubation failure and neurologic injury during airway management or position change. We experienced two cases that patients had cervical spine instability and severe limited range of motion due to the fusion of the entire cervical spine. One patient was a 6-year-old girl weighing 12.7 kg and had Klippel-Feil syndrome with Arnold-Chiari malformation, the other was a 24-year-old female weighing 31 kg and had juvenile rheumatoid arthritis. We successfully performed the intubation by using the fiberoptic intubation though a laryngeal mask airway in these two cases.
Airway Management ; Arnold-Chiari Malformation ; Arthritis, Juvenile Rheumatoid ; Child ; Female ; Humans ; Intubation ; Klippel-Feil Syndrome ; Laryngeal Masks ; Neck ; Range of Motion, Articular ; Spine ; Young Adult

Gastric foregut duplication cyst is a rare congenital anomaly. There have been very few reports of bronchogenic cysts in the abdominal cavity attached to the stomach. We report a case of a 57-year-old Korean man with an adenocarcinoma arising within a bronchogenic cyst of the stomach. Pathologic findings revealed ciliated columnar epithelium lining the cyst and a solid papillary adenocarcinoma involving the subserosa of the stomach and the skeletal part of the diaphragm. Surgical resection is the treatment of choice for foregut cysts of the stomach, and the possibility of malignancy should be considered in patients with gastric duplication cysts.
Abdominal Cavity ; Adenocarcinoma ; Adenocarcinoma, Papillary ; Bronchogenic Cyst ; Diaphragm ; Epithelium ; Humans ; Middle Aged ; Stomach

BACKGROUND: Septic shock is a pathophysiologic state of circulatory failure with tissue hypoperfusion. However, it is usually defined as sepsis-induced hypotension not responding to fluid resuscitation, regardless of the objective findings of tissue hypoperfusion such as lactic acidosis or organ failures. Numerous patients with sepsis-induced hypotension present to the emergency department without hyperlactemia or severe organ failure. Hence, we investigated the clinical characteristics and outcomes of patients with septic shock according to the presence of hyperlactatemia or significant organ failure. METHODS: We conducted a retrospective observational study of adult patients presenting with septic shock in the emergency department of a tertiary care hospital between August 2008 and July 2010. Initial serum lactate was categorized low (<2.5 mmol/L) and high (> or =2.5 mmol/L). Organ failure was assessed by the Sequential Organ Failure Assessment (SOFA) score. Primary outcome measurement was in-hospital mortality. RESULTS: A total of 227 patients were enrolled. There were 88 (38.8%) patients in the low lactate group, and 139 (61.2%) patients in the high lactate group. Patients with low lactate levels showed a lower mortality rate (6.8% compared with 25.1% of those with high lactate level). The low lactate group showed less rapid heart rate, less severe organ failures and shorter length of stay in the intensive care unit. During the early goal-directed therapy, they required a smaller amount of fluid administration and a lower dose of norepinephrine although other hemodynamic variables were similarly maintained. In particular, if patients showed less severe organ dysfunction (SOFA score < 8) in the low lactate group (n = 45), in-hospital mortality was 0% (adjusted mortality was 1.3% [95% confidence interval = 0.3-5.0]). CONCLUSION: Patients with septic shock, who were enrolled according to the traditional definition, showed a very favorable outcome if they did not have hyperlactatemia or significant organ failure.
Acidosis, Lactic ; Adult ; Emergencies ; Heart Rate ; Hemodynamics ; Hospital Mortality ; Humans ; Hypotension ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Norepinephrine ; Resuscitation ; Retrospective Studies ; Sepsis ; Shock ; Shock, Septic ; Tertiary Healthcare

The genus Alternaria contains several species of melanized hypomycetes that cause opportunistic human infections. The most frequent clinical manifestations of alternariosis are cutaneous and subcutaneous infections, followed by oculomycosis, invasive and non-invasive rhinosinusitis, and onychomycosis. So far, only 17 cases of rhinosinusitis caused by Alternaria species have been reported since 1977. Although several domestic cases of cutaneous alternariosis have been reported, there is no report of Alternaria rhinosinusitis in Korea. The majority of Alternaria rhinosinusitis involves immunocompromised patients. We report the first case of alternariosis in a patient with neutropenia and myelodysplastic syndrome that was treated with endoscopic debridement and a conventional antifungal agent.
Alternaria ; Alternariosis ; Debridement ; Eye Infections, Fungal ; Humans ; Immunocompromised Host ; Korea ; Myelodysplastic Syndromes ; Neutropenia ; Onychomycosis ; Sinusitis