Stenting for Symptomatic Vertebral Artery Stenosis Associated with Bilateral Carotid Rete Mirabile: The Long-Term Clinical and Angiographic Outcome

Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rete mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.     

Suppressive effects of Schizandra chinensis Baillon water extract on allergy-related cytokine generation and degranulation in IgE-antigen complex-stimulated RBL-2H3 cells

Schizandra chinensis Baillon is a traditional folk medicine plant that is used to treat and prevent several inflammatory diseases and cancer in Korea, but the underlying mechanisms involved in its anti-allergic activity are not fully understood. This study was designed to investigate mechanisms of anti-allergic activity of a Schizandra chinensis Baillon water extract (SCWE) in immunoglobulin E (IgE)-antigen complex-stimulated RBL2H3 cells and to assess whether gastric and intestinal digestion affects the anti-allergic properties of SCWE. Oxidative stress is an important consequence of the allergic inflammatory response. The antioxidant activities of SCWE increased in a concentration-dependent manner. RBL-2H3 cells were sensitized with monoclonal anti-dinitrophenol (DNP) specific IgE, treated with SCWE, and challenged with the antigen DNP-human serum albumin. SCWE inhibited β-hexosaminidase release and expression of interleukin (IL)-4, IL-13, and tumor necrosis factor-alpha (TNF-α) mRNA and protein in IgE-antigen complex-stimulated RBL2H3 cells. We found that digested SCWE fully maintained its antioxidant activity and anti-allergic activity against the IgE-antigen complex-induced activation of RBL-2H3 cells. SCWE may be useful for preventing allergic diseases, such as asthma. Thus, SCWE could be used as a natural functional ingredient for allergic diseases in the food and/or pharmaceutical industries.     

How Do Families Manage Their Economic Hardship?

Using data from the 2007 Survey of Consumer Finances, this study examined how families manage their economic hardship. A conceptual model was developed based on risk management theory and the permanent income hypothesis. About half of families used credit and about a third used their own savings to make up the difference between income and spending. The results of multinomial logit analysis showed that families' use of management methods differed when they faced economic hardship, depending on their situation.     

Blood perfusion and transcutaneous oxygen level characterizations in human skin with changes in normal and shear loads — Implications for pressure ulcer formation

BackgroundDecubitus ulcers (pressure ulcers) are localized areas of tissue breakdown in the skin and the underlying regions. Decubitus ulcers affect approximately 3 million people in the USA every year, including seniors, individuals with diabetes, and those who spend long periods in wheelchairs. Experimental studies demonstrate that static or dynamic normal loads cause blood occlusion in the skin, while prolonged loading conditions can result in skin damage. However, few studies report the effects of ‘normal and shear’ combined loading on blood perfusion. The goal of this research was to study alterations of transcutaneous oxygen levels and blood perfusion in human skin when both normal and shear loads were applied.MethodsFifteen human subjects were evaluated under seven different conditions for changes in transcutaneous oxygen and blood perfusion levels during applications of normal and shear loading on the forearm. Transcutaneous oxygen levels and blood perfusion were continuously measured using a Laser Doppler system, while applied forces were quantified with a multi-axis load cell.FindingsTranscutaneous oxygen and blood perfusion levels decreased when shear loads were applied in addition to normal loads. Further, blood perfusion during recovery periods increased gradually from the first to the last test condition.InterpretationResults indicate that adding shear loads decreased transcutaneous oxygen and blood perfusion levels in the skin. Based on these findings, shear force may play a role in skin damage, and both shear and normal loads should be considered when trying to prevent ulcer development.     

Clinical characteristics of papillary thyroid microcarcinoma less than or equal to 5 mm on ultrasonography

Management of papillary thyroid microcarcinoma sized ≤5 mm identified on ultrasonography is controversial. In this study, we evaluated the clinical characteristics of papillary thyroid microcarcinoma sized ≤5 mm on ultrasonography in comparison to those >5 mm and sought to present rationales for optimal management in papillary thyroid microcarcinoma ≤5 mm. The medical records of 396 patients who underwent surgery for papillary thyroid carcinoma between 2009 and 2011 were retrospectively analyzed. The patients were grouped into A (≤5 mm, n = 132) or B (>5 mm, n = 264) and the clinicopathologic characteristics of the patients were reviewed and compared between the two groups. Tumor capsular invasion (45.5 vs. 59.8 %, p = 0.007) and cervical lymph node metastasis (18.2 vs. 29.2 %, p = 0.018) were more frequent in group B. Nonetheless, group A presented lymph node metastasis in 42.3 % of multifocal cases showing no difference to that of group B (41.5 %, p = 0.946) and also included five cases (3.8 %) of lateral neck metastasis. Multifocality was the only predictive factor for lymph node metastasis in group A (p < 0.001). Over half (55.3 %) of the patients of group A were diagnosed with papillary carcinoma in private clinics; however, only 5.5 % of these patients underwent assessment of lateral neck lymph nodes initially. In conclusion, higher risk of cervical lymph node metastasis should be considered in evaluation and surgical decision of papillary thyroid microcarcinoma ≤5 mm identified on ultrasonography with multifocality. Evaluation of the cervical lymph nodes including the lateral neck should not be overlooked when suspicious thyroid nodule suggesting malignancy sized ≤5 mm shows multifocal lesions.