Effects of cyclosporine on oxidative stress in human bronchial epithelial cells

Objectives

Some of the airway complications relate to the use of cyclosporine (CsA), a potent agent widely used after organ transplantations. Several recent studies have demonstrated CsA treatment to induce reactive oxygen species (ROS). The present study was undertaken to investigate effects of CsA on production of ROS and antoxidant defense of airway cells using the human bronchial epithelial cell line BEAS-2B.

Methods

We measured biological antioxidant potential (BAP), as well as ROS and malondialdehyde levels in BEAS-2B cells after CsA treatment, using Free Radical Analytical System 4 kits (Diacron, Grosseto, Italy). ROS production was expressed as Carr Units as established by the manufacturer and BAP as μmol/2 × 10⁵ cells; malondialdehyde, by the thiobarbituric acid assay.

Results

ROS production was increased in the BEAS-2B cells after CsA treatment: 73.5 at 0 (controls); 82.5 at 10; 84.0 at 30; 86.0 at 50; and 93.0 Carr Unit/2 × 10⁵ cells at 100 μg/mL of CsA. The levels of BAP were 1821 at 0 (controls), 1698 at 10; 1653 at 30; 1366 at 50 μg/mL; and 1391 at 100 μg/mL. The levels of malondialdehyde were increased: 3.8 at 0 (controls); 3.4 at 10; 4.4 at 30; 4.2 at 50: and 5.0 nmol/10⁶ cells at 100 μg/mL.

Conclusions

Increased production of ROS and decreased BAP by CsA in BEAS-2B cells may increase malondialdehyde levels by radical-induced damage.     

The washout rate on the delayed CT image as a diagnostic tool for adrenal adenoma verified by pathology: a multicenter study

Objectives

To establish the undisputed the value of washout rate for adrenal adenoma using delayed enhanced CT, we evaluated diagnostic performance of cut-off value and delayed time of washout rate by final pathologic diagnosis in a multicenter study.

Methods

We reviewed the pathologic and clinical records of 244 patients underwent adrenalectomies at 5 university hospitals between 2005 and 2009. We calculated the mean Housfield units (HU) of adrenal lesion at non-enhancing CT, and early and delayed enhanced CT using the region of interest. We used ROC curves to determine the specificity and sensitivity of non-enhanced CT scans and the washout rate according to the various cut-off for adrenal adenomas.

Results

We divided the patients into adrenal adenoma group (n?=?138) and non-adrenal adenoma group (n?=?106) based on final pathologic report. Using the unenhanced images with a threshold of 10 HU, the sensitivity was 45.7?%, and the specificity was 97.1?%. Using the 15-min-washout rate with a threshold of 55?%, the sensitivity was 93.9?%, and the specificity was 95.8?%.

Conclusions

Regardless of various CT machines and protocols, a washout rate of 15-min-delayed CT was most useful in the diagnosis of adrenal adenomas due to the early inflow and outflow of contrast media in the tissues of adrenal adenomas.     

Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine

Purpose

Pain on propofol injection is a common adverse effect. This study examined the effect of a combination of nitroglycerin and lidocaine on pain during propofol injection compared to lidocaine alone.

Methods

In a double-blind, prospective trial, 90 patients scheduled to undergo elective plastic surgery were allocated randomly to three groups, to receive lidocaine 20?mg (n?=?30), a combination of lidocaine 20?mg and nitroglycerin 0.1?μg/kg (n?=?30), or normal saline as a placebo (n?=?30), with venous occlusion for 1?min, followed by the administration of 25?% of the total calculated dose of propofol (2?mg/kg) into a dorsal hand vein. The pain intensity during the propofol injection was assessed using a four-point scale (0?=?none, 1?=?mild, 2?=?moderate, 3?=?severe). Hemodynamic variables–mean arterial pressure and heart rate–were measured during the preoperative and intraoperative periods.

Results

A significantly higher proportion of patients in the placebo group (83?%) experienced pain compared to the lidocaine and combination groups (43 and 7?%, respectively; both, P?<?0.01). The incidence of pain in the combination group was lower than that in the lidocaine group (P?<?0.01). The pain score (median) was lower in the lidocaine (0) and combination (0) groups than in the placebo group (2); (P?<?0.01). The hemodynamic variables were similar in the three groups.

Conclusion

A combination of nitroglycerin 0.1?μg/kg and lidocaine 20?mg with venous occlusion for 1?min was more effective than lidocaine 20?mg alone in decreasing pain during propofol injection.     

Adult-to-adult living donor liver transplantation at the Asan Medical Center,Korea

Between February 1997 and December 2001, 311 adult-to-adult living donor liver transplants (A-A LDLTs) were performed at the Asan Medical Center for patients above 20 years of age. Indications for A-A LDLT were: chronic hepatitis B (203), chronic hepatitis C (5), hepatocellular carcinoma (64), alcoholic cirrhosis (9), cryptogenic cirrhosis (4), secondary biliary cirrhosis (5), primary biliary cirrhosis (1), Wilson' s disease (2), autoimmune hepatitis (1), hepatic tuberculosis (1), cholangiocarcinoma (1), fulminant hepatic failure (14) and primary non-function of cadaveric liver graft (1). Of 311 A-A LDLTs, 36 were of medical high urgency, 20 were for acute and subacute hepatic failure, 15 were for hepato-renal syndrome and 1 was for primary non-function. Recipient age ranged from 27 to 64 years. Donor age ranged from 16 to 62 years. There was no donor mortality. Implanted liver grafts were categorized into seven types: 175 modified right lobe (MRL), 70 left lobe, 32 right lobe, 20 dual grafts, 10 left lobe plus caudate lobe, three extended right lobe and one posterior segment. In MRL, the tributaries of the middle hepatic vein were reconstructed by interpositioning a vein graft. Indication for dual graft implantation was the same as single graft A-A LDLT, and four of 20 were emergency cases. Of 20 dual grafts, 14 received two left lobes, four received a left lobe and a lateral segment, one received a right lobe and a left lobe and one received a lateral segment and a posterior segment. Graft volume ranged from 28% to 83% of the standard liver volume of the recipients. There were 33 (10.6%) in-hospital mortalities (< 4 months) among the 310 patients after 311 A-A LDLTs. Of the 36 patients receiving emergency transplants, 31 survived. These encouraging results justify the expansion of A-A LDLT in coping with increasing demands, even in urgent situations. We have aimed to introduce the establishment of the efficacy of A-A LDLT in various end-stage chronic and acute liver diseases, as well as new technical advances to overcome small graft-size syndrome by using dual-graft implantation and MRL, both of which were first developed in our department.     

Randomized comparison of the effectiveness of nasal intubation using a GlideScope video laryngoscope with Magill forceps <Emphasis Type="Italic">versus</Emphasis> vascular forceps in patients with a normal airway

Purpose

The GlideScope^® video laryngoscope (GVL) is widely used for nasotracheal intubation in dental and facial plastic surgery. The angle of the Magill forceps is different from that of the GVL blade, which suggests that the Magill forceps are not the ideal forceps for use with the GVL. The purpose of this study was to compare the effectiveness of the Magill forceps vs vascular forceps for nasotracheal intubation using the GVL.

Methods

This study included 60 patients scheduled to undergo elective surgery requiring nasotracheal intubation. Patients were assigned to one of two groups—i.e., Magill forceps (group M) or vascular forceps along with a tube exchanger (group V), by computer randomization. The primary outcome was total intubation time, defined as the time from when the anesthesiologist picked up the device to the time when three successive end-tidal CO₂ waves were obtained following intubation. Secondary outcomes were blood in the endotracheal tube and trauma to the oral tissues or teeth. A blind observer assessed the presence of sore throat one hour and 24 hr after surgery.

Results

The total intubation time was significantly different between group M and group V (96.1 sec and 78.1 sec, respectively; mean difference, 18 sec; 95% confidence interval (CI), 13.7 to 49.7). The incidence of epistaxis in group M was significantly greater than that in group V (46.7% vs 16.7%, respectively; relative risk, 2.8; 95% CI, 1.2 to 6.8).

Conclusion

The total intubation time was significantly less with the vascular forceps (and tube exchanger) than with the Magill forceps. Using vascular forceps also reduced the incidence of epistaxis compared with that using the Magill forceps. Using a tube exchanger and vascular forceps offers advantages over use of Magill forceps when a GlideScope video laryngoscope is used for nasotracheal intubation.Trial registration: http://www.who.int/ictrp/network/cris2/en/, CRIS, KCT0001310. Registered 29 July 2014.

     

Can partial nephrectomy provide equal oncological efficiency and safety compared with radical nephrectomy in patients with renal cell carcinoma (≥4 cm)? A propensity score–matched study

Objective

Although partial nephrectomy (PN) is the standard treatment for localized clinical T1a renal cell carcinoma (RCC), treatment of larger renal tumors is controversial. We evaluated the oncological outcomes and perioperative complications after radical and PN for RCC ≥4 cm.

Effects of tissue-cultured mountain ginseng （Panax ginseng CA Meyer） extract on male patients with erectile dysfunction

Korean ginseng and mountain ginseng （Panax ginseng CA Meyer） are important traditional herbal plants whose ginsenosides are generally accepted as serving to improve sexual functions, such as penile erection. We investigated the effects of tissue-cultured mountain ginseng extract （TMGE） on male patients with erectile dysfunction （ED）. A double-blind, placebo-controlled study was conducted with 143 patients experiencing ED. Over the course of 8 weeks, one group took 1 000 mg of TMGE twice a day, and the other group took 1 000 mg of placebo twice a day. The effects of the TMGE and the placebo were analyzed using the Korean version of the International Index of Erectile Function （IIEF） questionnaire. A total of 86 patients completed 8 weeks of treatment. The scores on the five domains of the IIEF after medication were significantly higher than the baseline scores in the group treated with TMGE （P 〈 0.05）, whereas no significant improvement was observed in the placebo group （P 〉 0.05）. Erectile function and overall satisfaction scores after medication were significantly higher in the TMGE group than in the placebo group （P 〈 0.05）. Erectile function of patients in the TMGE-treated group significantly improved, suggesting that TMGE could be utilized for improving erectile function in male patients.     

Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more

BACKGROUND: The time for femoral lengthening is shortened if external fixation is combined with intramedullary nailing. However, several complications have been reported with this procedure. PATIENTS AND METHODS: We retrospectively reviewed the outcome of femoral lengthening performed over an intramedullary nail using external fixation in 22 patients. These patients were followed for a mean of 3.2 (2-5.2) years. The mean age was 22 (13-35) years at the time of the index procedure. The mean lengthening was 5 (2.7-8.1) cm and the external fixator was removed after median 20 (8-30) weeks. The mean external fixation index was 24 (11-35) days/cm and the mean consolidation index was 43 (26-55) days/cm of lengthening. RESULTS: 3 patients who had a past history of infection or open trauma developed osteomyelitis which required removal of the nail. There were 4 knee joint complications when the lengthening was over 20%, including posterior knee subluxation and patella subluxation. In 1 patient, the lengthened segment collapsed with breakage of locking screws. INTERPRETATION: Although lengthening over a nail can reduce the duration of external fixation, caution is required to prevent major complications.     

Comparison of postoperative optical quality according to the degree of decentering of V4c implantable collamer lens

AIM: To evaluate the clinical outcomes of V4c implantable collamer lens (Hole ICL) implantation with regard to the optical quality assessed according to different degrees of decentering. METHODS: This included 49 eyes that received conventional ICL and 94 eyes that received Hole ICL. The eyes that received Hole ICL were divided into three groups according to the degree of decentering: group 1, central hole within 1 hole diameter (HD) from the pupil center; group 2, central hole within 1 HD to 2 HD; and group 3, central hole within 2 HD to 3 HD. Visual acuity (VA), intraocular pressure (IOP), and spherical equivalent (SE) values were assessed at 1wk, 1 and 3mo after surgery. The ocular modulation transfer function, Strehl ratio, objective scattering index, and higher order aberrations (HOAs) were measured for 4-mm pupils at 3mo after surgery. RESULTS: There were no significant differences in VA, IOP, and SE among the conventional and Hole ICL groups. With regard to HOAs, values for coma and spherical aberrations showed no differences. The total HOA and trefoil values were significantly higher in group 2 than in group 1 (P=0.02, 0.03, respectively). There were no significant differences among groups with regard to other optical quality parameter at 3mo after surgery. CONCLUSION: Our results suggest that Hole ICL implantation provides satisfactory visual quality that is equivalent to that provided by conventional ICL, regardless of the presence of central hole and degree of decentering.     

004 65岁以上收缩功能正常的心衰者的临床特点

众所周知,充血性心衰(CHF)为老年人较为常见的临床综合征之一.迄今关于左室收缩功能正常的CHF老人的相关临床特点远未清楚,本文特此进行了大样本分析. 对象与方法 4842例老年人,男1922例,女2920例,年龄66～103岁.尔后人均随访1年.旨在分析老年CHF年发病率,以及左室收缩功能正常的CHF老人相关临床特点. 结果随访期内,罹发1次或以上CHF者共425例次(8.8%/年).与未患发CHF老人相比,CHF老人平均年龄更大(79±6岁:77±5岁,P＜0.001),女性居多,尤以高龄女性更多,如85岁以上的高龄女性CHF年发病率约较65～69岁女性高2倍(14%∶6.6%,P＜0.001),AMI史、房颤、高血压、糖尿病、慢性阻塞型肺病、吸烟者均多,血脂及血肌酐亦高.多变量分析表明,罹患CHF与下列因素有关:老年尤其是高龄[年龄每增加5岁的患病奇数率(OR)女性1.2,男性1.1],AMI史(OR7.3),房颤者(OR3.0),糖尿病(OR2.1),肾功能不全(血肌酐≥1.5mg/dl的OR2.0),慢性阻塞肺病(仅老年女性的OR为1.8),以及左房、左室内径增大(内径每递增1cm的OR为2.0),和左室重量增加、左室收缩末期室壁张力增高、早期跨心房血流增多.超声心动图检测结果显示,CHF老人中,左室收缩功能正常者达55%,而仅有左室舒张功能不全,且左室收缩功能正常或轻度减退者高达80%.其中女性左室收缩功能正常者尤较男性多见(67%∶42%,P＜0.001),表现为单纯左室舒张功能不良.而在左室收缩功能正常的CHF老人,常伴有左室内径较小、左室收缩末期室壁张力较低、左室重量较轻、左室收缩末期室壁厚度增加,而左室射血分数正常或仅轻度降低. 讨论以上结果提示,在老年人群中,CHF年发病率相对较高,且随年龄而增加,多数左室收缩功能正常,仅有左室舒张功能障碍,尤其是在高龄女性,亦即高龄女性左室舒张功能不全性CHF更为常见.对此,临床上更应拟出合理的防范措施,来正确诊治老年CHF综合征. (袁志敏摘)