The gastrointestinal tract is the first organ directly affected by fasting. However, little is known about how fasting influences the intestinal immune system. Intestinal dendritic cells (DCs) capture antigens, migrate to secondary lymphoid organs, and provoke adaptive immune responses. We evaluated the changes of intestinal DCs in mice with short-term fasting and their effects on protective immunity against Listeria monocytogenes(LM). Fasting induced an increased number of CD103 + CD11b − DCs in both small intestinal lamina propria (SILP) and mesenteric lymph nodes (mLN). The SILP CD103 + CD11b − DCs showed proliferation and migration, coincident with increased levels of GM-CSF and C-C chemokine receptor type 7, respectively. At 24 h post-infection with LM, there was a significant reduction in the bacterial burden in the spleen, liver, and mLN of the short-term-fasted mice compared to those fed ad libitum. Also, short-term-fasted mice showed increased survival after LM infection compared with ad libitum-fed mice. It could be that significantly high TGF-β2 and Aldh1a2 expression in CD103 + CD11b - DCs in mice infected with LM might affect to increase of Foxp3 + regulatory T cells. Changes of major subset of DCs from CD103 + to CD103 - may induce the increase of IFN-γ–producing cells with forming Th1-biased environment.Therefore, the short-term fasting affects protection against LM infection by changing major subset of intestinal DCs from tolerogenic to Th1 immunogenic.

Background: Osteoporotic vertebral compression fractures (OVCFs) are often associated with delayed myelopathy. Surgical treatment of delayed myelopathy following an OVCF comprises spinal canal decompression and stable fixation of the vertebral column with an acceptable sagittal alignment. However, such surgical methods are not usually feasible because of medical comorbidities and osteoporosis. We devised a novel, simple technique to decompress the spinal canal and reconstruct the middle column by translating the fractured vertebral body anteriorly through a posterior approach and verified the validity of the new technique. Methods: We conducted a single-center, retrospective study. Patients who underwent vertebral body anterior translation (VBaT) between 2014 and 2017 due to delayed myelopathy after OVCFs were included. Through a posterior approach, discs between the fractured vertebra and the adjacent vertebrae were released. The fractured vertebra was translated anteriorly with pedicle screws and rods to realign the middle column. Radiological and functional improvement was analyzed. Results: There were 12 consecutive patients. The mean age was 70.3 ± 9.4 years. There were 8 female and 4 male patients. Follow-up period was 35.9 ± 13.1 months. Nine patients had pedicle screw augmentation with polymethyl methacrylate. The mean number of fusion segments was 3.4 (range, 2–4). There were 3 types of spinal canal invasion. Five patients had vertebral body vacuum clefts with posterior wall fractures. Five patients had vertebral body angulation with endplate protrusion. Two patients had 3 column fractures. In radiological analysis, the regional kyphotic angle was 35.1° ± 9.1° preoperatively and improved to 8.8° ± 6.8° postoperatively and 9.8° ± 6.1° at the final follow-up (p < 0.001). The anterior vertebral body height ratio was 27.6% ± 7.0% preoperatively and improved to 80.5% ± 13.7% postoperatively and 83.7% ± 12.5% at the final follow-up (p < 0.001). The spinal canal invasion ratio was 52.6% ± 9.1% preoperatively and improved to 25.2% ± 10.4% postoperatively (p < 0.001). Neurological deficit was improved in all patients by 1–3 grades according to Nurick’s grading system. Conclusions In delayed myelopathy following an OVCF, although the posterior cortex invades the spinal canal, it is usually already in the union state. Therefore, it can bear compression force as a middle column if realigned to be in line with the adjoining vertebrae. VBaT demonstrated satisfactory reduction of kyphosis and maintenance of stability until the last follow-up.

OBJECTIVE: To determine the optimal CT image reconstruction parameters for the measurement of early transmitral peak velocity (E), early peak mitral septal tissue velocity (E′), and E / E′. MATERIALS AND METHODS: Forty-six patients underwent simultaneous cardiac CT and echocardiography on the same day. Four CT datasets were reconstructed with a slice thickness/interval of 0.9/0.9 mm or 3/3 mm at 10 (10% RR-interval) or 20 (5% RR-interval) RR-intervals. The E was calculated by dividing the peak transmitral flow (mL/s) by the corresponding mitral valve area (cm²). E′ was calculated from the changes in the left ventricular length per cardiac phase. E / E′ was then estimated and compared with that from echocardiography. RESULTS: For assessment of E / E′, CT and echocardiography were more strongly correlated (p < 0.05) with a slice thickness of 0.9 mm and 5% RR-interval (r = 0.77) than with 3 mm or 10% RR-interval. The diagnostic accuracy of predicting elevated filling pressure (E / E′≥ 13, n = 14) was better with a slice thickness of 0.9 mm and 5% RR-interval (87.0%) than with 0.9 mm and 10% RR-interval (71.7%) (p = 0.123) and significantly higher than that with a slice thickness of 3 mm with 5% (67.4%) and 10% RR-interval (63.0%), (p < 0.05), respectively. CONCLUSION: Data reconstruction with a slice thickness of 0.9 mm at 5% RR-interval is superior to that with a slice thickness of 3 mm or 10% RR-interval in terms of the correlation of E / E′ between CT and echocardiography. Thin slices and frequent sampling also allow for more accurate prediction of elevated filling pressure.
Dataset ; Echocardiography* ; Heart Ventricles ; Humans ; Image Processing, Computer-Assisted ; Mitral Valve ; Ventricular Function

PURPOSE: The purpose of this study was to identify the changes in the characteristics of patients with carbon monoxide (CO) poisoning, as well as the distinctive differences in intentionally exposed patients. METHODS: The medical records of CO poisoning patients, who visited nine emergency departments between January 2010 and December 2011, were reviewed retrospectively. The clinical information including age, gender, hospitalization, type of discharge, cause and location of exposure, site of onset, concentration of initial blood carboxyhemoglobin (COHb), methods of treatment and presence of neurological complications was examined. The subjects were divided into an intentional and non-intentional group and the differences between them was compared. RESULTS: A total 209 subjects were recruited. The median age was 38 years (29~49.5 years). They frequently complained of nausea and vomiting, and the most common exposures occurred in winter, normally in the home. The cause of exposure was usually fire, followed by incomplete combustion of fuels. The median initial blood COHb was 13.15%. The proportion of intentionally exposed patients was 21%. They were significantly younger, more frequently discharged against medical advice, and showed a higher initial blood COHb level (22.85%) than the non-intentional group. CONCLUSION: This study suggests that those with intentional CO poisoning are normally discharged against medical advice even when they have a higher initial COHb level. An adequate explanation of the delayed neurologic sequelae and short term follow-up observation is recommended for those patients with intentional exposure.
Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Carboxyhemoglobin ; Emergencies ; Fires ; Follow-Up Studies ; Hospitalization ; Humans ; Intention ; Medical Records ; Nausea ; Retrospective Studies ; Suicide ; Vomiting

BACKGROUND: Failed percutaneous transluminal coronary angioplasty (PTCA) is occasionally required for emergency coronary artery bypass grafting (CABG). The aim of this study was to assess the outcome of patients receiving emergency CABG after failed PTCA. MATERIAL AND METHOD: Between May 1988 and May 2005, 5712 patients underwent PTCA, where 84 (1.4%) failed. 27 patients underwent emergency CABG after failed PTCA. The mean age was 63.7+/-8.9 (46~80) years, with 14 male patients (51.9%). RESULT: All patients underwent emergent surgical revascularization within 6 hours. 22 patients underwent conventional CABG and 5 underwent off-pump CABG. The causes of PTCA failure were coronary obstruction due to new thrombi formation during the procedure (n=4), coronary dissection (n=17), coronary artery rupture (n=3) and 3 due to other causes. The rate of in-hospital operative mortality after emergent operation was 18.5% (5/27). A univariate analysis revealed that patients who died more often had left anterior descending artery disease, a preprocedural shock status, postoperative use of multiple isotropics and postoperative use of intra-aortic balloon pump. The mean follow up duration was 53.6+/-63.4 months. CONCLUSION: Although PTCA is known to be life saving, there is still a high risk for morbidity and mortality following emergency CABG after failed PTCA, despite the advancement in PTCA techniques. This result will help identify and more effectively treat patients selected for PTCA when emergency CABG is required.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Bypass* ; Coronary Vessels* ; Emergencies* ; Follow-Up Studies ; Humans ; Male ; Mortality ; Rupture ; Shock

Subperiosteal hematoma of the orbit is a rare disease and most of the cases occur in young adult males as a result of direct facial or orbital trauma. In the absence of direct facial or orbital trauma, nontranmatic subperiosteal orbital hematoma has rarely been reported in association with a sudden elevation of cranial venous pressure or venous congestion, systemic diseases associated with a bleeding diathesis and paranasal sinusitis. We report here on a rare case of subperiosteal orbital hematoma associated with ethmoid sinusitis, as was seen on CT imaging.
Disease Susceptibility ; Ethmoid Sinus* ; Ethmoid Sinusitis* ; Hematoma* ; Hemorrhage ; Humans ; Hyperemia ; Male ; Orbit* ; Rare Diseases ; Sinusitis ; Venous Pressure ; Young Adult

PURPOSE: We measured the inter-rater reliability and validity of the modified Emergency Severity Index-2 ((m)ESI-2) as a triage tool in the emergency department (ED). METHODS: We applied (m)ESI-2 to 2,724 patients who visited three EDs. In each ED, emergency medicine residents, interns, and nurses independently evaluated the severity of the patient with (m)ESI-2. Data on the triage result, the patient disposition, and the length of stay in the ED were collected prospectively. For patients who were admitted or who stayed more than 24 hours in the ED, the APACHE II score was calculated. RESULTS: The weighted kappa value was 0.602 between residents and interns, 0.541 between residents and nurses, and 0.451 between interns and nurses. Hospitalization (ED death, admission, transfer) rates were 100% in category 1 and 82.4%, 53.8%, 17.2%, 6.2% in categories 2 through 5, respectively. The mean length of stay was longest in category 3 (687 min) and shortest in category 5 (150 min). The mean APACHE II score was highest in category 1 (10.8) and 8.6, 6.2, 5.2, 2.9 in categories 2 through 5, respectively. CONCLUSION: The (m)ESI-2 demonstrated good to fair interrater reliability among residents, interns, and nurses, and the resultant categories were related with the hospitalization rates, the length of stay in the ED, and the APACHE II score. With further modification and refinement, (m)ESI-2 can be a reliable and a valid triage tool in the ED.
APACHE ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Hospitalization ; Humans ; Length of Stay ; Prospective Studies ; Reproducibility of Results* ; Triage*

PURPOSE: The tumor suppressor gene, p53, has been established as an essential component for the suppression of tumor cell growth. In this study, we investigated the time-course anticancer effects of adenoviral p53 (Adp53) infection on human ovarian cancer cells to provide insight into the molecular-level understanding of the growth suppression mechanisms involved in Adp53-mediated apoptosis and cell cycle arrest. MATERIALS AND METHODS: Three human cervical cancer cell lines (SiHa, CaSki, HeLa and HT3) were used. The effect of Adp53 infection was studied via cell count assay, cell cycle analysis, FACS, Western blot and macroarray assay. RESULTS: Adp53 exerts a significant role in suppressing cervical cancer cell growth. Adp53 also showed growth inhibitory effects in each cell line, and it induced apoptosis and cell cycle arrest. Adp53 differentially regulated the expression of genes and proteins, and the gene expression profiles in the SiHa cells revealed that the p21, p53 and mdm2 expressions were significantly up-regulated at 24 and 48 hr. Western blot shows that the p21 and p53 expressionlevels were significantly increased after Adp53 infection. In addition, in all cell lines, both the CDK4 and PCNA protein expression levels were decreased 48 h after Adp53 infection. Cell cycle arrest at the G1 phase was induced only in the SiHa and HeLa cells, suggesting that exogenous infection of Adp53 in cancer cells was significantly different from the other HPV-associated cervical cancer cells. CONCLUSION: Adp53 can inhibit cervical cancer cell growth through induction of apoptosis and cell cycle arrest, as well as through the regulation of the cell cycle-related proteins. The Adp53-mediated apoptosis can be employed as an advanced strategy for developing preferential tumor cell-specific delivery.
Adenoviridae* ; Apoptosis ; Blotting, Western ; Cell Count ; Cell Cycle Checkpoints ; Cell Cycle* ; Cell Line ; G1 Phase ; Genes, Tumor Suppressor ; Genetic Therapy ; HeLa Cells ; Humans* ; Ovarian Neoplasms ; Papilloma* ; Proliferating Cell Nuclear Antigen ; Transcriptome ; Uterine Cervical Neoplasms*

Clinical results of minimally invasive mitral valve surgery were retrospectively reviewed, and two different surgical approaches were compared in this study. Between 1997 and 2004, a total of 86 patients with mitral valve disease underwent minimally invasive surgery at theYonsei University Cardiovascular Center. Age of patients averaged 41.6 +/- 14.0 years and 69 patients were female. Surgical approach included low-sternal incisions with mini-sternotomy, and right parasternal or thoracotomy approach. Either direct aortic or femoral arterial and bicaval cannulations were used in all patients. Patients were divided into two groups according to the method of surgical approach (parasternal (P) vs low-sternal (L)), and the results were compared. Postoperative NYHA functional class improved to 1.1 +/- 0.4 in all patients (no significant statistical difference between two groups). Mean wound length (P: 9.21 +/- 1.10 vs L: 11.24 +/- 0.82 cm, p < 0.05), and mechanical ventilation time (P: 10.42 +/- 4.36 vs L: 12.90 +/- 5.00 min, p=0.04) was significantly shorter in parasternal group, and mean operation time(P:294.74 +/- 59.41 vs. L:259.31 +/- 54.36 min, p=0.03) was significantly shorter in low-sternal group. Mean cardiopulmonary bypass time, and aortic cross clamp time was also shorter in low-sternal group without statistical difference. There were 2 minor wound complications in all patients (p=NS), and no hospital death. Comparing the two different surgical approach of minimally invasive mitral valve surgery, parasternal approach is thought to be more beneficial in reducing postoperative scar, and intubation time.
Time Factors ; Surgical Procedures, Minimally Invasive/*methods ; Sternum/surgery ; Retrospective Studies ; Models, Statistical ; Mitral Valve Insufficiency/*diagnosis/*therapy ; Mitral Valve/*pathology/surgery ; Middle Aged ; Male ; Humans ; Heart Valve Prosthesis Implantation/methods ; Female ; Cardiopulmonary Bypass ; Cardiac Surgical Procedures/*methods ; Aged ; Adult ; Adolescent