The global obesity epidemic and associated metabolic diseases require alternative biological targets for new therapeutic strategies. In this study, we show that a phytochemical sulfuretin suppressed adipocyte differentiation of preadipocytes and administration of sulfuretin to high fat diet-fed obese mice prevented obesity and increased insulin sensitivity. These effects were associated with a suppressed expression of inflammatory markers, induced expression of adiponectin, and increased levels of phosphorylated ERK and AKT. To elucidate the molecular mechanism of sulfuretin in adipocytes, we performed microarray analysis and identified activating transcription factor 3 (Atf3) as a sulfuretin-responsive gene. Sulfuretin elevated Atf3 mRNA and protein levels in white adipose tissue and adipocytes. Consistently, deficiency of Atf3 promoted lipid accumulation and the expression of adipocyte markers. Sulfuretin’s but not resveratrol’s anti-adipogenic effects were diminished in Atf3 deficient cells, indicating that Atf3 is an essential factor in the effects of sulfuretin. These results highlight the usefulness of sulfuretin as a new anti-obesity intervention for the prevention of obesity and its associated metabolic diseases.
Activating Transcription Factor 3 ; Adipocytes ; Adiponectin ; Adipose Tissue, White ; Animals ; Diet* ; Insulin Resistance ; Metabolic Diseases* ; Mice ; Mice, Obese* ; Microarray Analysis ; Obesity* ; RNA, Messenger

BACKGROUND: The aim of this study was to compare the clinical outcomes of the sedative, analgesic, and hemodynamic effects of dexmedetomidine and midazolam for sedation after coronary artery bypass grafting (CABG). METHODS: The adult patients undergoing elective CABG surgery under general anesthesia were randomly assigned to the dexmedetomidine (DEX) and midazolam (MDZ) groups. From the time of the sternal closure, dexmedetomidine (0.5–0.7 μg/kg/h) was continuously administered (DEX group), and midazolam (0.03–0.1 mg/kg) was administered by bolus (MDZ group). To maintain the target sedation level (Richmond Agitation-Sedation Scale [RASS] range, −2 to −1) until extubation in the intensive care unit (ICU), continuous doses of dexmedetomidine were regulated and midazolam was administered intermittently. Sedation (RASS) and pain scores (visual analogue scale) and hemodynamic changes were recorded every two hours, until the end of the mechanical ventilation assistance after entering the ICU. RESULTS: The mean of the fraction within the target sedation level in each patient's total sedation time was 41.0% in the DEX group and 20.7% in the MDZ group (P = 0.026). In the DEX group, the RASS (P < 0.001) and cardiac index were lower (P = 0.047) than those in the MDZ group, but the other hemodynamic parameters and pain scores were not different. CONCLUSIONS: This study showed that post-operative infusion of dexmedetomidine maintained a stable sedation without side effects in patients who underwent CABG surgery.
Adult ; Anesthesia, General ; Conscious Sedation ; Coronary Artery Bypass ; Dexmedetomidine ; Hemodynamics ; Humans ; Intensive Care Units ; Midazolam ; Postoperative Care ; Respiration, Artificial ; Thoracic Surgery

OBJECTIVES: The purpose of the study was to compare plaque characteristics by coronary computed tomography angiography (CCTA) with those by virtual histology-intravascular ultrasound (VH-IVUS). METHODS: We enrolled 50 asymptomatic patients with diabetes mellitus or more than two risk factors for coronary artery disease such as hypertension, smoking, and hyperlipidemia. If the patient had a coronary lesion (plaque with more than 50% stenosis or calcium score more than 100), we recommended coronary angiography and VH-IVUS and compared CCTA findings with VH-IVUS findings. RESULTS: 35 patients (70%) had coronary lesions, and we performed both CCTA and VH-IVUS in 23 patients. All 23 patients had multiple risk factors, and the majority of target lesions were located at left anterior descending artery (73.9%), and calcium score of lesion site was 106+/-162 with plaque volume of 232+/-153 mm3 by CCTA. Calcium score of lesion site was significantly greater in diabetic patients (n=14) than non-diabetic patients (n=9) (118+/-159 vs. 88+/-175, p=0.038). By VH-IVUS, plaque volume was 174+/-127 mm3, absolute necrotic core (NC) volume was 22+/-21 mm3, and relative NC volume was 20.8+/-8.7%. Absolute dense calcium (DC) volume and absolute NC volumes were significantly greater in diabetic patients than non-diabetic patients (11.5+/-13.8 mm3 vs. 9.1+/-11.0 mm3, p=0.028, and 23.9+/-24.7 mm3 vs. 18.1+/-14.3 mm3, p=0.035, respectively). Plaque volume by CCTA correlated with that of VH-IVUS (r=0.742, p<0.001), and plaque volume by CCTA correlated with absolute NC volume by VH-IVUS (r=0.621, p<0.001), and calcium score of lesion site by CCTA correlated with absolute dense calcium volume by VH-IVUS (r=0.478, p=0.028). CONCLUSION: Coronary lesion was detected by CCTA in 70% of asymptomatic patients with multiple coronary risk factors, and parameters detected by CCTA correlated well with those detected by VH-IVUS.
Angiography* ; Arteries ; Calcium ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease* ; Diabetes Mellitus ; Humans ; Hyperlipidemias ; Hypertension ; Risk Factors* ; Smoke ; Smoking ; Ultrasonography*

A neurofibroma is a benign tumor of the peripheral nerve sheath characterized by proliferation of Schwann cells, perineural cells, and endoneurial fibroblasts. Different types of neurofibromas can be identified, including localized, plexiform, and diffuse types. Neurofibromas can involve any site on the body skin. The diffuse variant is rare and occurs primarily in children and young adults. It involves the skin and subcutaneous tissue in a plaque-like fashion on the head and neck regions. We present a case of a 10-year-old boy who had a diffuse neurofibroma on the scalp.
Child ; Fibroblasts ; Head ; Humans ; Neck ; Neurofibroma ; Peripheral Nerves ; Scalp ; Schwann Cells ; Skin ; Subcutaneous Tissue ; Young Adult

The skin lesion of herpes zoster is classically limited to a single dermatome, and most cases of multi-dermatomal herpes zoster have contiguous skin lesions. Noncontigous multi-dermatomal herpes zoster is very rare in both immunocompetent and immunosuppressed persons. The phenomenon of zoster occurring in two non-contiguous dermatomes has been referred to as zoster duplex unilateralis or bilateralis. We report here on a case of herpes zoster duplex bilateralis in a 49-year-old woman who had previously received chemotherapy for breast cancer treatment.
Breast ; Breast Neoplasms ; Female ; Herpes Zoster ; Humans ; Middle Aged ; Skin

Epidermal nevi are harmatormas that are the result of developmental malformations of the epidermis, and these lesions present with a variety of clinical and histological characteristics. Some tumors can arise in epidermal nevi because epidermal nevi develop from multipotent germinative cells. We report here on a 57-year-old woman who had epidermal nevi arranged in a linear pattern since childhood. Her epidermal nevi were located in her left chest, arm and shoulder, upon which multiple trichillemal cysts seemed to develop after several years. We think that this patient with linear epidermal nevi associated with multiple trichilemmal cysts is a rare and distinctive case.
Arm ; Epidermis ; Female ; Humans ; Middle Aged ; Nevus ; Shoulder ; Thorax

Spindle cell lipoma is a benign, subcutaneous neoplasm typically located on the neck, back and shoulder of men. Pseudoangiomatous spindle cell lipoma is a rare variant of spindle cell lipoma that is characterized by non-vascular branching spaces. A 64-year old man presented with 2 masses on the abdomen. Although 1 tumor had a very low fat component, it could be histologically diagnosed as pseudoangiomatous spindle cell lipoma due to CD 34 positive spindle cells, ropey collagen and blood vessels. We report a case of pseudoangiomatous spindle cell lipoma on the abdomen, which was diagnostically difficult due to a scanty fat component.
Abdomen ; Blood Vessels ; Collagen ; Humans ; Lipoma ; Male ; Neck ; Shoulder

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. To solve the problem of emergency medical service in elderly patients, it is very important to analyze the emergency patients who visit medical service and to accumulate date bases of various hospitals. So the purpose of this study is to evaluate the use of emergency services by the elderly to provide better understanding of the emergency care needs of this specialized populations and provide a basis planning to meet the needs of the expanding geriatric population. METHODS: We performed a retrospective study of 2380 elderly patients who visited Emergency room of national medical center, from August 1, 1999 to July 31, 2000. We analyzed the patients gender, age, arrival time, final diagnosis, admission rate, mortality, ects. RESULT: Male to female ratio is 1:1.29, and most common age group was between 65 and 69 years old. The peak time of patients entrance was between 10 AM and 11AM, in a week monday was most crowding day. The most predomint monthly distribution of visit was January. The respiratory disease are most common problem (14.7%), and cardivascular disease (12.01%) are next, and cerebrovascular disease (11.17%) are following. Diabetic complication (7.53%) are common problems and hypoglycemia and diabetic foot infection are frequent. Admission rates was 32.53%. ICU admission rate is 2.77%. Emergency operation rate is 5.91%. During admission, mortality case was 127 patients. The cause of death were cerebrovascular disease (16.94%) and advanced respiratory disease (15.43%). CONCLUSION: The results show that cerebrovascular disease and respiratory disease and cardiovascular disease that needed prompt medical service are major problem who visit emergency room. And diabetic complications that are prevented by proper educations are common. So more concentrated medical service and preventive effort focused on these disease.
Aged* ; Cardiovascular Diseases ; Cause of Death ; Crowding ; Diabetes Complications ; Diabetic Foot ; Diagnosis ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Female ; Humans ; Hypoglycemia ; Korea ; Male ; Mortality ; Retrospective Studies

Aneurysms arising from the proximal segment(A1) of anterior cerebral artery are rare and not classified as a separate entity. This study reviewed clinical features of A1 aneurysms in four patients the authors experienced with analysis of neurological status, radiological findings, surgical management and outcome. The incidence of A1 aneurysms among 648 aneurysmal patients operated between January. 1995. and January 1998 was 0.6%. The cases were divided into two groups according to the location of aneurysm in the course of A1 segment: distal aneurysm of A1 segment arising near the anterior communicating artery(3 cases) and proximal aneurysm of A1 segment arising near the bifurcation of internal carotid artery(1 case). All three patients of distal aneurysm showed Hunt & Hess grade III-IV on admission and intraventricular hemorrhages in CT scan, on the other hand, one patient of proximal aneurysm showed Hunt & Hess grade II and no other hemorrhage except subarachnoid hemorrhage. In microsurgical fields, the domes of aneurysm of A1 segment directed superiorly in all cases, and in 2 cases of distal aneurysm, the domes were embedded within adjacent parenchyma of gyrus rectus. Distal fenestration of A1 segment which could not be detected in preoperative angiogram was found in 2 cases of distal aneurysm. The authors propose that aneurysms of A1 portion may tend to arise mainly at the distal portion of A1 segment and tend to be accompanied with distal fenestration, and also consider that, when outbreak of aneurysmal rupture, it may give rise to intraventricular hemorrhage through the frontal horn of lateral ventricle due to superior direction of aneurysm and tendency of embedding within brain parenchyma of gyrus rectus, and then it makes the patient worse than aneurysmal rupture of other common sites.
Aneurysm ; Animals ; Anterior Cerebral Artery* ; Brain ; Hand ; Hemorrhage ; Horns ; Humans ; Incidence ; Intracranial Aneurysm* ; Lateral Ventricles ; Rupture ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed