Remifentanil is commonly used in operating rooms and intensive care units for the purpose of anesthesia and sedation or analgesia. Although remifentanil may significantly affect the bone regeneration process in patients, there have been few studies to date on the effects of remifentanil on bone physiology. The purpose of this study was to investigate the effects of remifentanil on osteoclast differentiation and bone resorption. Bone marrow-derived macrophages (BMMs) were cultured for 4 days in remifentanil concentrations ranging from 0 to 100 ng/ml, macrophage colony-stimulating factor (M-CSF) alone, or in osteoclastogenic medium to induce the production of mature osteoclasts. To determine the degree of osteoclast maturity, tartrate-resistant acid phosphatase (TRAP) staining was performed. RT-PCR and western blotting analyses were used to determine the effect of remifentanil on the signaling pathways involved in osteoclast differentiation and maturation. Bone resorption and migration of BMMs were analyzed to determine the osteoclastic activity. Remifentanil reduced the number and size of osteoclasts and the formation of TRAP-positive multinuclear osteoclasts in a dose-dependent manner. Expression of c-Fos and NFATC1 was most strongly decreased in the presence of RANKL and remifentanil, and the activity of ERK was also inhibited by remifentanil. In the bone resorption assay, remifentanil reduced bone resorption and did not significantly affect cell migration. This study shows that remifentanil inhibits the differentiation and maturation of osteoclasts and reduces bone resorption.
Acid Phosphatase ; Analgesia ; Anesthesia ; Blotting, Western ; Bone Regeneration ; Bone Resorption* ; Cell Movement ; Humans ; Intensive Care Units ; Macrophage Colony-Stimulating Factor ; Macrophages ; Operating Rooms ; Osteoclasts* ; Physiology

Human dermal fibroblast is essential in wound healing of the skin through the synthesis of extracellular matrix proteins. With respect to oxidative stress, the effects of remifentanil on human dermal fibroblast have received little attention. Therefore, we investigated the effects of remifentanil on the apoptosis and autophagic reaction of human dermal fibroblasts under oxidative stress. The subjects were divided into the following groups: Control group: cells were incubated at 37℃ in a humidified atmosphere with 5% CO₂. Hydrogen peroxide (H₂O₂) group: cells were exposed to H₂O₂ for 2 h. RPC/H₂O₂ group: cells were pretreated with remifentanil for 2 h and exposed H₂O₂ for 2 h. 3-MA/RPC/H₂O₂ group: cells were pretreated with 3-methyladenine (3-MA) and remifentanil for 1 h and 2 h, respectively. We measured cell viability using MTT assay. Western blot analysis was used to determine the expression levels of proteins associated with apoptosis and autophagy. Quantification of apoptotic cells was performed using flow cytometer analysis, and autophagic vacuoles were observed under a fluorescence microscope. Remifentanil treatment increased the proliferation of human dermal fibroblast and decreased apoptotic cell death, enhancing autophagic activity under oxidative stress. However, 3-MA, the autophagy pathway inhibitor, inhibited the protective effect of remifentanil in oxidative stress. This study demonstrates that remifentanil activated autophagy and decreased apoptotic death of human dermal fibroblasts under oxidative stress. Our results suggest that remifentanil may help in the treatment of oxidative stress.
Apoptosis ; Atmosphere ; Autophagy ; Blotting, Western ; Cell Death ; Cell Survival ; Extracellular Matrix Proteins ; Fibroblasts* ; Fluorescence ; Humans* ; Hydrogen Peroxide ; Oxidative Stress* ; Skin ; Vacuoles ; Wound Healing

OBJECTIVES: Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. METHODS: Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period. RESULTS: The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total. CONCLUSION: The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.
Cartilage* ; Cicatrix ; Follow-Up Studies ; Humans ; Mastoid ; Otologic Surgical Procedures ; Pain Measurement ; Pain, Postoperative ; Postoperative Complications ; Thoracic Wall ; Tissue and Organ Procurement ; Tissue Donors ; Transplants

Tympanic membrane (TM) perforation is common. Acute persistent or chronic TM perforations require surgical interventions such as myringoplasty or tympanoplasty. Current strategies of tissue engineering are focused on the regeneration of TM perforation instead of surgical interventions. To regenerate TM tissue or restore acoustic-mechanical property, bioscaffold or growth factors are necessary that will act as a temporary matrix for cell proliferation and extracellular matrix deposition, with subsequent ingrowths. In recent years, various scaffolds, biomolecules have been used for TM tissue engineering. Cells in combination with supportive scaffolds have rarely reported. TM regeneration by tissue engineering approach may be considered the greatest advances in otology. This review examines the current evidence for their use and the limitations of knowledge.
Cell Proliferation ; Extracellular Matrix ; Intercellular Signaling Peptides and Proteins ; Myringoplasty ; Otolaryngology ; Regeneration* ; Tissue Engineering* ; Tympanic Membrane* ; Tympanoplasty

Osteomas in the middle ear are very rare. To date, there are 23 cases of osteomas of the middle ear reported in the English literature. Of these, five osteomas arose from the ossicles, but those accompanied by cholesteatoma is extremly rare. There are only two cases that are all congenital cholesteatoma. Ossicular osteoma with primary acquired cholesteatoma has not been reported previously. We present a case of osteoma of the incus accompanied by primary acquired cholesteatoma, which was diagnosed incidentally in the middle ear.
Cholesteatoma ; Ear, Middle ; Incus ; Osteoma

Inverted papilloma is an uncommon benign nasal tumor which usually occurs on the lateral nasal wall. An inverted papilloma originating from the medial nasal cavity, especially the nasal septum, is considered very rare. A 47-year-old male was referred with a 1-month history of snoring. On endoscopic examination, a nasal mass was observed in the left posterior septum. The mass filled the left nasal cavity and extended choanae and nasopharynx. The histopathologic examination of the nasal mass showed inverted papilloma, which was completely removed by endoscopic surgery. Herein, the authors report a case of inverted papilloma originating from the posterior nasal septum as well as a review of literature.
Humans ; Male ; Middle Aged ; Nasal Cavity ; Nasal Septum ; Nasopharynx ; Papilloma, Inverted ; Snoring

BACKGROUND: During the 2009 influenza pandemic in Korea, school-age children were mostly attacked by the novel influenza A virus (H1N1). Nevertheless, there is limited information on the cumulative incidence of the 2009 influenza pandemic among school populations. The aim of this study was to estimate the incidence of 2009 H1N1 influenza and influenza-like illness (ILI), and characterize the epidemiology among school-based populations in Korea. MATERIALS AND METHODS: This study analyzed the data collected by the daily school influenza reporting system for laboratory-confirmed influenza (H1N1 2009 pdm) and ILI in elementary, middle and high schools in Korea during the period, July 1 to December 20, 2009. RESULTS: Between July 1 and December 20, 2009, a total of 525,668 cases of H1N1 2009 pdm were reported from the schools analyzed. The cumulative incidence of H1N1 2009 pdm was highest in elementary school children between 8 and 13 years of age (11,058 per 100,000 population), followed by middle school students between 14 and 16 years of age (10,080 per 100,000), and high school students between 17 and 19 years of age (8,886 per 100,000). With the alignment of the epidemic curves by the three levels of school education, the age group-specific differences in the timing of the infection became apparent. The infections peaked 1 week earlier in both middle and high school students (November 3, 2009) than in elementary school children (November 10, 2009). The infections occurred an average of 7.3 [95% confidence interval(CI): 7.2-7.4] and 3.4 (95% CI: 3.3-3.5) days earlier in the middle and high school students, respectively, than elementary school children (P<0.001). The overall trend of the epidemic waves from the school reporting system data was similar to that of the national surveillance date from the Korea Centers for Disease Control and Prevention. CONCLUSIONS: This study suggests that during the 2009 pandemic, one student in every 10 was infected with H1N1 2009 pdm, which is double that estimated from the national surveillance data. In addition, middle and high school students were important drivers of H1N1 2009 pdm transmission in 2009. During the 2009 influenza pandemic, the daily school reporting system provided valuable information for estimating the incidence as well as the epidemiological characteristics in school-based populations.
Centers for Disease Control and Prevention (U.S.) ; Child ; Humans ; Incidence ; Influenza A virus ; Influenza, Human ; Korea ; Pandemics

BACKGROUND: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). MATERIAL AND METHOD: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. RESULT: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). CONCLUSION: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.
Ants ; Brachial Plexus Neuropathies ; Chest Tubes ; Drainage ; Female ; Ganglioneuroma ; Humans ; Mediastinum ; Neurilemmoma ; Neurofibroma ; Retrospective Studies ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy ; Vocal Cord Paralysis

Myelopathy is a rare but serious central nervous system complication associated with systemic lupus erythematosus (SLE). Acute transverse myelitis is the most usual involvement of SLE-related myelopathy. We reported a 17-year-old girl who developed a very extensive SLE related transverse myelitis with longitudinal involvement of the spinal cordfrom C4 to the conus medullaris. There were motor and sensory loss of both lower extremities, and bladder dysfunction over the course of 5 days. She presented T9 paraplegia ASIA A. Her neurological dysfunction was not responded to treatment with methyprednisolone and cyclophosphomide.
Adolescent ; Asia ; Central Nervous System ; Conus Snail ; Female ; Humans ; Lower Extremity ; Lupus Erythematosus, Systemic* ; Myelitis* ; Myelitis, Transverse ; Paraplegia ; Spinal Cord Diseases ; Urinary Bladder

OBJECTIVE: To evaluate immediate and long term effects of electrical stimulation on upper extremity spasticity following stroke. METHOD: The subjects were 13 hemiplegic patients with cerebral infarction and cerebral hemorrhage. Electrical stimulation was applied to skin over the biceps muscle and the triceps muscle for a period of twenty minutes. The evaluation of spasticity was done by using the modified Ashworth scale, free amount of elbow extension, active range of motion and motor strength of elbow flexion and extension at baseline, immediately, 1 week and 4 weeks after electrical stimulation. RESULTS: Immediately after treatment, free amount of elbow extension increased from 63.8+/-19.1 degrees to 77.7+/-22.5 degrees (p<0.05) and active flexion of elbow flexor increased from 45.0+/-34.8 degrees to 55.3+/-39.1 degrees (p<0.05). The active range of motion of elbow flexor was increased on the 4th week during electrical stimulation (p<0.05). The free amount of elbow extension and modified Ashworth scale of elbow flexor spasticity was improved on the 18th day after treatment cessation (p<0.05). CONCLUSION: The results of this study showed that spasticity tended to decrease and maintain a lower level after a varying number of treatment sessions.
Cerebral Hemorrhage ; Cerebral Infarction ; Elbow ; Electric Stimulation* ; Hemiplegia ; Humans ; Muscle Spasticity* ; Range of Motion, Articular ; Skin ; Stroke ; Upper Extremity* ; Withholding Treatment