Operational tolerance (OT), defined as maintaining stable graft function without immunosuppression after transplant surgery, is an ideal goal for kidney transplant recipients (KTRs). Recent investigations have demonstrated the distinctive features of B cells, T cells, and dendritic cell-related gene signatures and the distributions of circulating lymphocytes in these patients; nonetheless, substantial heterogeneities exist across studies. This study was conducted to determine whether previously reported candidate gene biomarkers and the profiles of lymphocyte subsets of OT could be applied in Korean KTRs. Peripheral blood samples were collected from 153 patients, including 7 operationally tolerant patients. Quantitative real-time PCR and flow cytometry were performed to evaluate gene expression and lymphocyte subsets, respectively. Patients with OT showed significantly higher levels of B cell-related gene signatures (IGKV1D-13 and IGKV4-1), while T cell-related genes (TOAG-1) and dendritic cell-related genes (BNC2, KLF6, and CYP1B1) were not differentially expressed across groups. Lymphocyte subset analyses also revealed a higher proportion of immature B cells in this group. In contrast, the distributions of CD4⁺ T cells, CD8⁺ T cells, mature B cells, and memory B cells showed no differences across diagnostic groups. An OT signature, generated by the integration of IGKV1D-13, IGKV4-1, and immature B cells, effectively discriminated patients with OT from those in other diagnostic groups. Finally, the OT signature was observed among 5.6% of patients who had stable graft function for more than 10 years while on immunosuppression. In conclusion, we validated an association of B cells and their related signature with OT in Korean KTRs.
B-Lymphocytes ; Biomarkers ; Flow Cytometry ; Gene Expression ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Lymphocyte Subsets ; Lymphocytes ; Memory ; Precursor Cells, B-Lymphoid ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; T-Lymphocytes ; Transplant Recipients* ; Transplants

BACKGROUND: This study evaluated the efficacy of ulinastatin for attenuating organ injury and the release of proinflammatory cytokines due to cardiopulmonary bypass (CPB) during cardiac surgery. METHODS: Patients undergoing valvular heart surgery employing CPB were assigned to receive either ulinastatin (group U, n = 13) or a placebo (group C, n = 11) before the commencement of CPB. Hemodynamic data, parameters of major organ injury and function, and proinflammatory cytokines were measured after the induction of anesthesia (T1), after CPB (T2), at the end of anesthesia (T3), and at 24 hours after surgery (POD). RESULTS: The demographic data, CPB duration, and perioperative transfusions were not different between the groups. PaO2/FiO2 in group U was significantly higher than that in group C at T3 (3.8 +/- 0.8 vs. 2.8 +/- 0.7, P = 0.005) and at POD (4.0 +/- 0.7 vs. 2.8 +/- 0.7, P < 0.001). Creatine kinase-MB at POD in group U was significantly lower than that in group C (17.7 +/- 8.3 vs. 33.7 +/- 22.1, P = 0.03), whereas troponin I at POD was not different between the groups. Creatinine clearance and the extubation time were not different between the groups at POD. The dopamine infusion rate during the post-CPB period in group U was significantly lower than that in group C (1.6 +/- 1.6 vs. 5.5 +/- 3.3 microg/kg/min, P = 0.003). The interleukin-6 and tumor necrosis factor-alpha concentrations at T1, T2, and T3 as well as the incidences of postoperative cardiac, pulmonary and kidney injuries were not different between the groups. CONCLUSIONS: Ulinastatin pretreatment resulted in an improved oxygenation profile and reduced inotropic support, probably by attenuating the degree of cardiopulmonary injury; however, it did not reduce the levels of proinflammatory cytokines.
Anesthesia ; Cardiopulmonary Bypass ; Creatine ; Creatinine ; Cytokines ; Dopamine ; Glycoproteins ; Hemodynamics ; Humans ; Incidence ; Interleukin-6 ; Kidney ; Oxygen ; Thoracic Surgery ; Troponin I ; Tumor Necrosis Factor-alpha

BACKGROUND/AIMS: Oxidative stress may contribute to gastric epithelial damage and mutagenesis caused by Helicobacter pylori (H. pylori). H. pylori induces recruitment and activation of inflammatory cells, which produces reactive oxygen species. H. pylori extract directly induces the synthesis of reactive oxygen species in gastric epithelial cells and causes DNA damage. The aim of this study was to investigate the association between the levels of glutathione (GSH) and H. pylori density, histological findings, endoscopic findings, clinical variables, and virulence factors. METHODS: Gastric biopsy specimens were obtained from 73 consecutive patients. The 5,5'-dithiobis-(2-nitrobenzoic acid) reaction was used to determine GSH levels. RESULTS: The infection rate of H. pylori was 68.5%. The GSH level was not related to age, sex, alcohol intake, and endoscopic findings. The GSH level was lower in patients infected with H. pylori. GSH levels were not correlated significantly with the grades of neutrophil, intestinal metaplasia, and atrophy. However, the GSH levels were significantly correlated with H. pylori density (r=-0.296, p=0.01) and monocyte grade (r=-0.257, p=0.02). The GSH levels were not related to CagA, VacA, and UreA. CONCLUSIONS: This study suggests that H. pylori causes oxidative stresses which deplete GSH in gastric mucosa of patients infected with H. pylori.
Adolescent ; Adult ; Aged ; Female ; Gastric Mucosa/*metabolism/pathology ; Glutathione/*metabolism ; Helicobacter Infections/*metabolism/pathology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Oxidative Stress ; Stomach Diseases/*metabolism/microbiology/pathology

BACKGROUND/AIMS: Oxidative stress may contribute to gastric epithelial damage and mutagenesis caused by Helicobacter pylori (H. pylori). H. pylori induces recruitment and activation of inflammatory cells, which produces reactive oxygen species. H. pylori extract directly induces the synthesis of reactive oxygen species in gastric epithelial cells and causes DNA damage. The aim of this study was to investigate the association between the levels of glutathione (GSH) and H. pylori density, histological findings, endoscopic findings, clinical variables, and virulence factors. METHODS: Gastric biopsy specimens were obtained from 73 consecutive patients. The 5,5'-dithiobis-(2-nitrobenzoic acid) reaction was used to determine GSH levels. RESULTS: The infection rate of H. pylori was 68.5%. The GSH level was not related to age, sex, alcohol intake, and endoscopic findings. The GSH level was lower in patients infected with H. pylori. GSH levels were not correlated significantly with the grades of neutrophil, intestinal metaplasia, and atrophy. However, the GSH levels were significantly correlated with H. pylori density (r=-0.296, p=0.01) and monocyte grade (r=-0.257, p=0.02). The GSH levels were not related to CagA, VacA, and UreA. CONCLUSIONS: This study suggests that H. pylori causes oxidative stresses which deplete GSH in gastric mucosa of patients infected with H. pylori.
Adolescent ; Adult ; Aged ; Female ; Gastric Mucosa/*metabolism/pathology ; Glutathione/*metabolism ; Helicobacter Infections/*metabolism/pathology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Oxidative Stress ; Stomach Diseases/*metabolism/microbiology/pathology

PURPOSE: Gallstone disease has been presumed to be a sequellae of gastrectomy. To know correlation between gallbladder disease and gastrectomy, we check anatomical and functional status of gallbladder with ultrasonogram in our study. METHODS: Gallbladder motility after gastrectomy was studied by means of measuring fasting and postprandial gallbladder volume using real time ultrasonography in 50 gastrectomized patients and in 28 controls (healthy but not operated gastric cancer patients) were selected as study subjects. RESULTS: Mean fasting and postprandial gallbladder volume was significantly increased in gastrectomized patient group (FV: 37.63+/-20.70 ml, PV: 11.50+/-10.26 ml) than control group (FV: 22.17+/-10.35 ml, PV: 5.44+/-3.67 ml, p<0.01). The ejection fraction of gallbladder in gastrectomized patient group (69.05+/-14.57%)was significantly smaller than control group (75.57+/-10.26%, p<0.05). CONCLUSION: The risk of gallbladder disease was independent of age, sex, and post-operative duration in our study. Gastrectomy may have the possibility of increasing the risk of gallbladder disease by causing gallbladder dysmotility and bile stasis. So, gallbladder motility evaluation would be helpful for prevention and understanding gallstone formation. Further study will be needed about the clinical benefits of prophylactic cholecystectomy during gastrectomy.
Bile ; Cholecystectomy ; Fasting ; Gallbladder Diseases ; Gallbladder* ; Gallstones* ; Gastrectomy* ; Humans ; Stomach Neoplasms* ; Ultrasonography

Biliary papilloma usually consists of single or multiple papillary adenomas in the biliary tract and has a potential for recurrence and malignant transformation. We described herein a case of papillary adenoma of intrahepatic duct that transformed into papillary adenocarcinoma. A 49-year-old male patient was admitted to our hospital because of right upper quadrant pain. A CT scan revealed marked dilatation of S7 segmental duct and cholangioscopy and biopsy revealed mucin-secreting papillary adenoma in the right intrahepatic duct. Three years later, a follow up of CT scan showed aggravated S7 ductal dilatation and inner ill-defined mass. Cholangioscopy revealed multiple papillary mucosal projections with large amount of mucin in the right intrahepatic duct and biopsy revealed well differentiated papillary adenocarcinoma. The patient underwent right lobectomy, the papillary adenocarcinoma was extended in the dilated right intrahepatic duct and also showed hepatic parenchymal invasion.
Adenocarcinoma, Papillary* ; Adenoma* ; Biliary Tract ; Biopsy ; Dilatation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mucins ; Papilloma ; Recurrence ; Tomography, X-Ray Computed

BACKGROUND: We designed this study to evaluate the antinociceptive effect and changes in amounts of substance P in the spinal cord after perineural application of capsaicin to the injured nerve in rats in neuropathic pain. METHODS: Male Sprague-Dawley rats (200-250 g) were prepared with the tight ligation of the left L5, 6 spinal nerves or with the sham operation. They were divided into 3 groups according to the solution treated to the left sciatic nerve and pre-treated condition, group I (capsaicin treatment after ligation; n = 10), group II (solvent treatment after ligation; n = 10), group III (capsaicin treatment after sham operation; n = 10). The withdrawal threshold to touch with von Frey filaments and the withdrawal time to thermal stimulus by plantar tester were measured and percent maximum possible effects (%MPE) were calculated, respectively, at 1, 2, 3 and 4 weeks after treatment. The area and integrity optical density (IOP) of substance P stained immunohistochemically in the lumbar dorsal horn were quantified with an image analyzer in group I. RESULTS: In the capsaicin-treated groups (I, III), withdrawal time to thermal stimulus was prolonged significantly during the 4 weeks as compared with baseline values before treatment (P < 0.05), but withdrawal time to touch didn't change. The %MPE of capsaicin to thermal stimulus in group I was significantly higher than that in group III (P < 0.05). In group II, withdrawal responses to touch and thermal stimulus didn't change. The area and IOP of substance P in the left lumbar dorsal horn at the 1st and 4th week didn't change, compared with the baseline before capsaicin treatment, except for theIOP at the 4th week in group I. CONCLUSIONS: Perineural application of capsaicin to the injured nerve in neuropathic rats does not inhibit hypersensitivity to touch but inhibit reaction to thermal stimulus. Its effect does not depend on the changes in amounts of substance P in the ipsilateral lumbar dorsal horn.
Animals ; Capsaicin* ; Horns ; Humans ; Hypersensitivity ; Ligation ; Male ; Neuralgia ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve ; Spinal Cord ; Spinal Nerves ; Substance P

BACKGROUND: COPA (cuffed oropharyngeal airway) is a convenient device for airway management in patients undergoing general anesthesia for elective surgery in supine position. It causes less pharyngeal trauma than LMA (Laryngeal mask airway). The purpose of this study was to compare the effect of COPA with and without muscle relaxant. METHODS: Forty patients with ASA physical status I and II for elective surgery were randomly assigned to two groups. Anaesthesia was induced with propofol (2 mg/kg) and vecuronium (1.5 mg/kg) and was administered intravenously in Group I but not in Group II. Mask ventilation was done for 5 min with O2 5 L/min. COPA was placed and heart rate, and systolic, mean, diastolic blood pressure and peak inspiratory pressure were measured at 1 min interval for 5 min. Anaesthesia was maintained with propofol 150 microgram/kg/min, fentanyl 1 microgram/kg/hr, O2 2 L/min and N2O 2 L/min. RESULTS: There were no significant differences between Group I and Group II in heart rate, systolic, mean and diastolic blood pressure. PIP (Peak inspiratory pressure) was increased and hiccups occurred significantly (p < 0.05) in Group II. Complete airway obstruction occurred in one patient of Group I and severe coughing, body movements and gagging occurred during induction and insertion in Group II. CONCLUSIONS: With the use of appropriate muscle relaxant, we can use COPA without increased inspiratory pressure or significant complication.
Airway Management ; Airway Obstruction ; Anesthesia, General ; Blood Pressure ; Cough ; Fentanyl ; Gagging ; Heart Rate ; Hiccup ; Humans ; Masks ; Propofol ; Supine Position ; Vecuronium Bromide ; Ventilation

We performed three kinds of problem-based learning (PBL) formulas in all of forty-one 3rd grade students after the final examination of the first semester from June 28, 1999 to July 9, 1999 at Konkuk University College of Medicine to investigate which formula is the most efficient and helpful in medical education and polyclinic course. The PBL formulas applied were the typical face-to-face PBL accompanied by mini-lecture (Type I) or by distribution of the guidelines without lecture (Type II) and cyber PBL using web-based module and discussion over cyber space (Type III). Response of students was surveyed using some questionnaires and the evaluation results of each PBL were analyzed with Pearson's correlation test. All participating students were satisfied with the face-to-face PBL especially in applying time of PBL, using discussion to solve the problem, and studying with tutors. In cyber PBL, in spite of excellency of the contents, limitations in discussion over cyber space and computer skills, misunderstanding of computer system, and additional cost for private PC rent seemed to decrease the satisfaction with this PBL. Experience in Type II PBL was turned out to be the most helpful and discussion among fellow students in PBL to be the most useful experience for incoming polyclinic course. There were no significant correlations between the evaluation results of face-to-face PBL and cyber PBL or between the evaluation results of each type of PBL and the average credit of that semester, suggesting that evaluation of the newly acquired knowledge through PBL using tools such as Triple Jump, OSCE (objective structured clinical examination), and MEQ (modified essay question) should be included in assesment of academic achievement in addition to the evaluation of activities during PBL.
Computer Systems ; Education, Medical ; Equidae ; Humans ; Problem-Based Learning* ; Surveys and Questionnaires

In this paper, we present some results from an experimental web-based Problem-Based Learning(PBL) course, which was offered to 64 medical students in the first grade at Konkuk university for 7 weeks. For the course, we developed a web-based PBL module, which is composed of three sections. The first section includes the 8 stages of problem probing and solving in patient's care. In every stage, the students can browse all the data for the problem solving. The second section contains some problems for evaluating the academic achievement of the students who successfully passed in the first section. In the third section, some questionnaires are presented to survey the students response. The followings are the results. 1. Average score of the first section was 64.1+/-13.2. Most students participated in the course with integrity, and especially seven students(11%) were remarkable in their clinical reasoning. 2.The student's computer skill did not largely affect their academic achievements. However, it is desirable for the students to learn basic computer usage in advance. 3.A few students attended to the discussion through bulletin board facilities. Considering the importance of discussion in PBL, we need to devise a new way of attracting students in the discussion. 4. The survey showed that sixty five percent of the students thought that the lecture was effective and ninety one percent of them that it would be better if it is offered as a regular course during summer or winter vacations. Seventy five percent of students became to realize the importance of basic sciences such as biochemistry and physiology after this course. 5. There were many students who complained about the malfunctioning of the system. The system should be modified to be more reliable and robust. In conclusion, the web-based PBL course provided an effective way of learning in medical education. It also turned out to be used as an alternative of traditional PBL and especially useful for self study.
Biochemistry ; Education, Medical ; Humans ; Learning ; Physiology ; Problem Solving ; Problem-Based Learning* ; Students, Medical ; Surveys and Questionnaires