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Ye Eun Kim,1,* Dong Hwan Kim,1,* Ami Choi,1,* Seoul Jang,1 Kwiwan Jeong,2 Young-mi Kim,1 Tae-gyu Nam1 1Department of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Gyeonggi-do, 15588, Republic of Korea; 2Gyeonggi Bio-Center, Gyeonggido Business & Science Accelerater, Suwon, Gyeonggi-do, 16229, Republic of Korea*These authors contributed equally to this workCorrespondence: Young-mi Kim; Tae-gyu Nam Tel +82-31-400-5815; +82-31-400-5807Fax +82-31-400-5958Email ymikim12@hanyang.ac.kr ; tnam@hanyang.ac.krIntroduction: Endoplasmic reticulum (ER) stress condition is characterized as the accumulation of misfolded or unfolded proteins in lumen of ER. This condition has been implicated in various diseases and pathologies including β-cell apoptosis, Alzheimer’s disease and atherosclerosis. We have reported that hydroxynaphthoic acids (HNA), naphthalene analogues of salicylic acid (SA), reduced ER stress. In this study, we explored structural modification to bi-aryl analogues of SA.Methods: Palladium-catalyzed cross-coupling was applied to synthesize bi-aryl analogues of SA. Anti-ER stress activity was monitored by using our cell-based assay system where ER stress is induced by tunicamycin. To monitor ER stress markers, ER stress was induced physiologically relevant palmitate system.Results: Many analogues decreased ER stress signal induced by tunicamycin. Compounds creating dihedral angle between Ar group and SA moiety generally increased the activity but gave some cytotoxicity to indicate the crucial role of flat conformation of aromatic region. The best compound (16e) showed up to almost 6-fold and 90-fold better activity than 3-HNA and tauro-ursodeoxycholic acid, positive controls, respectively. ER stress markers such as p-PERK and p-JNK were accordingly decreased in Western blotting upon treatment of 16e under palmitate-induced condition.Conclusion: Anti-ER stress activity and toxicity profile of bi-aryl analogues of SA could provide a novel platform for potential therapy for protein misfolding diseases.Keywords: endoplasmic reticulum stress, aryl-substituted salicylate, protein misfolding, biaryl group

Kwan-Sub Kim,1 Wu-Seop Lee,2 Haejun Cho,3 Sung-Min Shim,4 Soohyun Kwak,5 So-Young Ji,2 SangYoon Jeon,1 Yong-Min Kim61Department of Anesthesiology and Pain Medicine, Dongkang Medical Center, Ulsan, South Korea; 2Department of Plastic Surgery, Dongkang Medical Center, Ulsan, South Korea; 3Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, South Korea; 5Department of Rehabilitation Medicine, Semin Hospital, Ulsan, South Korea; 6Department of Chemical and Biomolecular Engineering, Hong Kong University of Science and Technology, Hong Kong, Hong KongAbstract: Although various cases of neuralgia and its treatments have been reported, not enough evidence is present to recommend a single type of treatment as the most effective. The patient we have dealt with experienced significant interferences in his daily life due to chronic allodynia, but the symptom could not be resolved via previously reported treatments. We report a case of which a patient who presented infraorbital neuralgia after trauma was successfully treated by a novel treatment strategy. The patient was treated by applying infraorbital nerve block and pulsed radiofrequency cautery side by side. Through this report, we evaluate proper prevention and treatment strategies for patients who develop infraorbital neuralgia through similar etiologies.Keywords: pulsed radio frequency, infraorbital nerve block, orbital wall fracture, ultrasound-guided, stellate ganglion block

Seong-Cheol Park,* Joung-Pyo Nam,* Young-Min Kim,* Jun-Ho Kim, Jae-Woon Nah, Mi-Kyeong Jang Biomedical Polymer Laboratory, Department of Polymer Science and Engineering, Sunchon National University, Suncheon, Republic of Korea *These authors contributed equally to this work Abstract: To generate a good carrier for gene transfection, O-carboxymethyl chitosan-graft-branched polyethylenimine (OCMPEI) copolymers were synthesized by increasing the weight percentage of branched polyethylenimine conjugated to the carboxyl groups of O-carboxymethyl chitosan. These spherical polyplexes with plasmid deoxyribonucleic acid (pDNA) or small interfering ribonucleic acid (siRNA) had diameters of ~200–300 nm or ~10–25 nm, respectively, and displayed significant transfection efficiency in normal and tumor cells. In particular, expression of green fluorescent protein (GFP) following pDNA transfection was effectively suppressed by delivery of GFP-specific siRNA with the same copolymer. The optimized copolymer and polyplexes were nontoxic in vitro and in vivo. The use of endocytosis inhibitors to investigate the mechanisms of transfection of the polyplexes suggested the involvement of macropinocytosis. An in vivo study in mice showed excellent GFP expression in the lung, kidney, and liver. The results demonstrated that the OCMPEI copolymer prepared in this study is a promising carrier for in vitro and in vivo gene delivery applications. Keywords: chitosan, branched polyethylenimine, gene transfection, cytotoxicity, endocytosis

Hwa-young Lee,1 Bong-Min Yang,1 Ji-min Hong,1 Tae-Jin Lee,1 Byoung-Gie Kim,2 Jae-Weon Kim,3 Young-Tae Kim,4 Yong-Man Kim,5 Sokbom Kang61Graduate School of Public Health, Seoul National University, Seoul, South Korea; 2Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, South Korea; 3Department of Obstetrics and Gynecology, Seoul National University, Seoul, South Korea; 4Department of Obstetrics and Gynecology, Yonsei University, Seoul, South Korea; 5Department of Obstetrics and Gynecology, University of Ulsan, Ulsan, South Korea; 6Department of Obstetrics and Gynecology, National Cancer Center, Kyeonggi-do, South KoreaObjective: We performed a cost–utility analysis to assess the cost-effectiveness of a chemotherapy sequence including a combination of polyethylene glycolated liposomal doxorubicin (PLD)/carboplatin versus paclitaxel/carboplatin as a second-line treatment in women with platinum-sensitive ovarian cancer.Methods: A Markov model was constructed with a 10-year time horizon. The treatment sequence consisted of first- to sixth-line chemotherapies and best supportive care (BSC) before death. Cycle length, a time interval for efficacy evaluation of chemotherapy, was 9 weeks. The model consisted of four health states: responsive, progressive, clinical remission, and death. At any given time, a patient may have remained on a current therapy or made a transition to the next therapy or death. Median time to progressions and overall survivals data were obtained through a systematic literature review and were pooled using a meta-analytical approach. If unavailable, this was elicited from an expert panel (eg, BSC). These outcomes were converted to transition probabilities using an appropriate formula. Direct costs included drug-acquisition costs for chemotherapies, premedication, adverse-event treatment and monitoring, efficacy evaluation, BSC, drug administration, and follow-up tests during remission. Indirect costs were transportation expenses. Utilities were also derived from the literature. Costs and utilities were discounted at an annual rate of 5% per cycle.Results: PLD/carboplatin combination as the second line in the sequence is more effective and costly than paclitaxel/carboplatin combination, showing an additional US$21,658 per quality-adjusted life years. This result was robust in a deterministic sensitivity analysis except when median time to progression of second-line therapies and administration cost of PLD/carboplatin per administration cycle were varied. The probability of cost-effectiveness for PLD/carboplatin combination was 49.4% at a willingness to pay $20,000.Conclusion: A PLD/carboplatin combination is an economically valuable option as second-line chemotherapy for the treatment of platinum-sensitive ovarian cancer in South Korea.Keywords: cost, utility, Markov modeling, ovarian cancer, chemotherapy

Several reports have promoted the root-derived Korean red ginseng (KRG; Panax ginseng) as alternative treatment for erectile dysfunction (ED), and ginsenosides are known to be the principal active ingredients of ginseng. Recent studies showed that ginseng berries produce more ginsenosides than KRG; thus, we investigated the ability of the Korean ginseng berry extract GB0710 to relax the penile corpus cavernosum smooth muscle (CCSM) in this study. As a comparative control, the results were compared to those obtained using KRG. In addition, possible mechanisms of action for GB0710 were investigated. While KRG and GB0710 both displayed dose-dependent relaxation effects on precontracted rabbit CCSM in vitro, GB0710 was shown to be more potent than KRG. The GB0710-induced relaxation could be partially reduced by removing the endothelium. In addition, pre-treatment with several nitric oxide (NO) inhibitors significantly inhibited the relaxation of muscle strips. Furthermore, administration of GB0710 increased intracavernosal pressure (ICP) in a rat in vivo model in both a dose- and duration-dependent manner. Intracellular NO production in human microvascular endothelial cells could be induced by GB0710 and inhibited by NG-monomethyl-L-arginine. In conclusion, GB0710 had a greater relaxation effect on rabbit CCSM than did KRG extract, and increased ICP in a rat model in both a dose- and a duration-dependent manner. This relaxing effect might be mediated by NO production. [ABSTRACT FROM AUTHOR]

C-peptide is a bioactive peptide with a potentially protective role in diabetes complications; however, its molecular mechanism of protection against cardiovascular damage caused by hyperglycemia-induced apoptosis remains unclear. We investigated the protective mechanism of C-peptide against hyperglycemia-induced apoptosis using human umbilical vein endothelial cells and streptozotocin diabetic mice. High glucose (33 mmol/L) induced apoptotic cell death in endothelial cells via sequential elevation of intracellular Ca(2+) and reactive oxygen species (ROS) as well as subsequent activation of transglutaminase 2 (TG2). C-peptide (1 nmol/L) prevented endothelial cell death by inhibiting protein kinase C- and NADPH oxidase-dependent intracellular ROS generation and by abolishing high glucose-induced TG2 activation, without affecting intracellular Ca(2+) levels. Consistently, in the aorta of streptozotocin diabetic mice, hyperglycemia stimulated transamidating activity and endothelial cell apoptosis that was inhibited by C-peptide replacement therapy (35 pmol/min/kg) using osmotic pumps (control and diabetes, n = 8; diabetes + C-peptide, n = 7). In addition, C-peptide prevented hyperglycemia-induced activation of transamidation activity and apoptosis in the heart and renal cortex of streptozotocin diabetic mice. Thus, C-peptide protects endothelial cells from hyperglycemia-induced apoptotic cell death by inhibiting intracellular ROS-mediated activation of TG2. Furthermore, TG2 may be a promising avenue of therapeutic investigation to treat diabetic vasculopathies. [ABSTRACT FROM AUTHOR]

Objective: The presence of an intratesticular solid lesion is usually highly suspicious for malignancy. Conversely, most extratesticular solid lesions including paratesticular lesions are benign. The characteristic imaging features of malignant solid testicular lesions are well known, but various unusual causes and imaging features of benign solid testicular lesions can be particularly misleading. Therefore, a careful assessment of solid testicular and paratesticular lesions is warranted. The purpose of this article is to present the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions.Methods: We demonstrate a variety of benign solid testicular and paratesticular lesions and correlate them with pathologic results.Results: Specific the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions have been described.Conclusions: Familiarity with the clinical setting and imaging features of benign solid testicular and paratesticular lesions should facilitate prompt, accurate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

It has been theorized that a traumatic tibial avulsion fracture of the posterior root of the medial meniscus (MM) is the cause of the so-called meniscus ossicle (MO). We report the delayed appearance of a tibial avulsion fracture of the posterior root of the MM after a valgus, twisting injury in a 12-year-old boy with open physes. Magnetic resonance imaging (MRI) scans performed 3 days after the injury did not demonstrate a definitive tibial avulsion fracture of the posterior root of the MM; whereas, a repeat MRI for 3 months post-injury did. Medial extrusion of the MM was also noted on the 3 month MRI. Arthroscopic reattachment of the avulsed posterior root of the MM using a trans-physeal nonabsorbable suture tied over a proximal tibia staple was performed. Follow-up MRI at 6 months postoperatively demonstrated healing of the tibial avulsion fracture of the posterior root of the MM in an anatomic position. The patient had a complete resolution of symptoms and there was no angular deformity or limb-length discrepancy at 2 years postoperatively. To our knowledge, this is the first report describing a tibial avulsion fracture of the posterior root of the MM in a skeletally-immature patient successfully treated by a trans-physeal arthroscopic suture. This case also illustrates the development of the MO of the posterior root of the MM. [ABSTRACT FROM AUTHOR]

This study compared the results of a tuberculin skin test (TST) and a whole-blood interferon-γ release assay (IGRA) to screen latent tuberculosis (TB) infection (LTBI) according to risk of TB exposure in South Korea. A cross-sectional comparison of 82 healthcare workers (HCWs) was performed from June 2009 to January 2010. Participants were grouped according to their risk for TB exposure: group 1, frequent and direct contact with active TB patients ( n = 35); group 2, no known history of direct contact with active TB patients ( n = 47). For the TST (10-mm induration cut-off), the positive response rate was 42.9% in group 1 and 34.0% in group 2 ( p = 0.42). For the IGRA, the positive response rate was 40% in group 1 and 10.6% in group 2 ( p = 0.002). Results obtained from the TST and the IGRA were not in significant agreement. The working duration of HCWs in TB-related departments was the only significant risk factor for LTBI (odds ratio 1.03; p = 0.031). Further, the IGRA can more accurately discriminate LTBI compared to the TST, based on the risk of TB exposure. These results suggest that the IGRA is diagnostically useful for LTBI in South Korean HCWs. [ABSTRACT FROM AUTHOR]

Aim. To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes. Background. Nurse staffing has been reported to influence patient and nurse outcomes. Design. A cross-sectional study with a survey conducted August-October 2007. Methods. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes. Results. The average patient-to-nurse ratio was 2·8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3·26; 95% confidence interval, 1·14-9·31) or 2·0-2·5 patients (odds ratio, 2·44; 95% confidence interval, 1·32-4·52), compared with having more than three patients. Perceived adequate staffing was related to a threefold increase (odds ratio, 2·97; 95% confidence interval, 2·22-3·97) in the odds of nurses' rating high quality and decreases in the odds of dissatisfaction (odds ratio, 0·30; 95% confidence interval, 0·23-0·40), burnout (odds ratio, 0·50; 95% confidence interval, 0·34-0·73) and plan to leave (odds ratio, 0·40; 95% confidence interval, 0·28-0·56). Conclusions. Nurse staffing was associated with quality of care and job outcomes in the context of Korean intensive care units. Relevance to clinical practice. Adequate staffing must be assured to achieve better quality of care and job outcomes. [ABSTRACT FROM AUTHOR]

This article presents a case review of a newborn diagnosed with a complex chromosomal rearrangement, as demonstrated through a painted chromosomal analysis. This infant presented with multiple dysmorphology including cutis aplasia, multiple ocular malformations, bilateral cleft lip and palate, and postnatal hydrocephaly. A chromosomal analysis revealed multiple-ways, balanced translocation involving chromosomes 3, 4, 6, 8, and 9. This case study provides a unique opportunity to, in retrospect, trace each malformation exploring the pathophysiology, etiology, and correlating origin with chromosomal variation. Careful review of this case, enhanced by the visually augmented representation of each translocation, will increase understanding of chromosomal anomalies and their implications in embryological development and clinical presentation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Interleukin-32 (IL-32) is a recently discovered cytokine that appears to play a critical role in human rheumatoid arthritis (RA). It is highly expressed in synovium and fibroblast-like synoviocytes (FLS) from RA patients, but not in patients with osteoarthritis (OA). This study was undertaken to assess IL-32 levels in RA synovial fluid (SF) and to investigate the secretion and regulation of IL-32 in RA FLS. METHODS: FLS and SF were obtained from the joints of RA patients. The secretion and expression of IL-32 and activation of signaling molecules were examined by enzyme-linked immunosorbent assay, immunoblotting, immunoprecipitation, reverse transcriptase-polymerase chain reaction, and small interfering RNA (siRNA) transfection. RESULTS: IL-32 levels were high in RA SF compared with OA SF. Furthermore, RA FLS expressed and secreted IL-32 when stimulated with tumor necrosis factor alpha (TNFalpha). TNFalpha-induced expression of IL-32 was significantly suppressed, in a dose-dependent manner, by inhibitors of Syk, protein kinase Cdelta (PKCdelta), and JNK and by knockdown of these kinases and c-Jun with siRNA. We also observed that PKCdelta mediated the activation of JNK and c-Jun, and experiments using specific inhibitors and siRNA demonstrated that Syk was the upstream kinase for the activation of PKCdelta. CONCLUSION: The present findings suggest that IL-32 may be a newly identified prognostic biomarker in RA, thereby adding valuable knowledge to the understanding of this disease. The results also demonstrate that the production of IL-32 in RA FLS is regulated by Syk/PKCdelta-mediated signaling events. [ABSTRACT FROM AUTHOR]

BACKGROUND: Family planning programmes in developing countries need a better understanding of nurse-patient communication in order to improve the quality of counselling. OBJECTIVES: To identify factors in the clinic and in the community that enable nurses and patients to communicate effectively with one another. DESIGN: The study explored the personal experiences of nurses and patients who communicate especially effectively during family planning consultations (so-called 'positive deviants'). SETTING: Sixty-four randomly selected public clinics located in East Java, Indonesia. PARTICIPANTS: Seven positive deviant nurses and 32 positive deviant patients were identified from among 64 nurses and 768 patients who participated in an earlier patient coaching study. Flooding prevented 5 patients from participating in the study, reducing their number to 27. METHODS: Investigators conducted: (1) a content analysis of qualitative data collected by structured in-depth interviews and focus-group discussions (FGDs) with positive deviant nurses and patients, and (2) analyses of variance (ANOVA) of quantitative data on clinic, nurse, and patient characteristics. RESULTS: Positive deviant nurses identified four factors, listed in rough order of importance, that helped them communicate effectively: independent study to strengthen their knowledge and skills; communication aids; feedback from colleagues; and motivation stemming from a desire to help people, patients' appreciation, husband's support, and increased income. Positive deviant patients identified five enabling factors: motivation due to their need for a service; confidence in their own communication skills; positive feedback from nurses; belief in patients' right and responsibility to communicate with nurses; and communication aids. CONCLUSIONS: Insights from positive deviant nurses and patients suggest that efforts to improve nurse-patient communication should go beyond conventional communication skills training. Managers should consider a mix of clinic-based interventions (such as peer feedback, communication aids, and better management of patient flow) and community-based interventions (such as patient education and mass media). [ABSTRACT FROM AUTHOR]

Background: The goal of the present study was to define the dimensions of the normal rotator interval with magnetic resonance arthrography and to compare these dimensions with those in shoulders with known chronic anterior instability in order to determine if abnormalities of the rotator interval might be better understood and estimated preoperatively.Methods: We retrospectively reviewed a consecutive series of 202 shoulders that had undergone magnetic resonance arthrography between 2004 and 2005. Of these, 120 shoulders were included in the present study. These shoulders were divided into two groups according to the diagnosis. Group I comprised fifty shoulders with no instability, and Group II comprised seventy shoulders with chronic anterior instability. With use of magnetic resonance arthrography, the base and height of the rotator interval and the diameter of the glenoid were measured. Then, the area of the rotator interval and the rotator interval index were calculated.Results: In Group I, the mean estimated rotator interval dimensions (height and base), the mean calculated rotator interval area, and the mean rotation interval index were 16.73 mm, 48.59 mm, 406.47 mm(2), and 0.64, respectively. In Group II, these values were 21.87 mm, 49.40 mm, 540.06 mm(2), and 0.94, respectively. The shoulders in Group II differed significantly from the shoulders in Group I in terms of rotator interval height, rotator interval area, and rotator interval index (p < 0.01 for all).Conclusions: There are significant differences in the dimensions of the rotator interval between patients with and without recurrent anterior shoulder instability. Estimating the dimensions of the rotator interval with use of magnetic resonance arthrography may be valuable for assessing patients preoperatively. [ABSTRACT FROM AUTHOR]

In health care consultations, patients often receive insufficient information from providers and communicate little with providers about their needs or concerns. This study evaluated a combined community education and mass media intervention to improve clients' participation in family planning consultations. A household survey was conducted with 1,200 women in three sub-districts (two intervention and one control) of West Java province in Indonesia. A comparison of post-campaign findings among family planning clients suggests that the intervention as a whole had a positive effect on client participation, specifically the number of clients who prepared questions to ask the service provider prior to a family planning visit in the past year. Multivariate analyses showed that the 'Smart Card' intervention and elements of the 'Sahabat' (Friend) mass media campaign were positively associated with clients' preparation of questions and question asking behavior during family planning consultations, indicating that a combined community education and mass-media approach can improve client communication with providers and improve the quality of family planning counseling. [ABSTRACT FROM AUTHOR]

Surfactant protein-A (SP-A) is produced by the fetal lung, participates in innate immunity, and has been proposed to play a role in the initiation of parturition in mice. Amniotic fluid SP-A concentration increases as a function of gestational age, and SP-A protein has been demonstrated in human chorioamniotic membranes. This study was conducted to determine whether parturition at term, gestational age and chorioamnionitis in preterm delivery (PTD) are associated with changes in the expression of SP-A in the chorioamniotic membranes. Chorioamniotic membranes were obtained from women at term and women with PTD ( n = 58). SP-A mRNA and protein expression was detected in amniotic epithelial cells, chorionic trophoblasts and macrophages by in situ hybridization and immunohistochemistry. Quantitative real-time reverse transcription-PCR demonstrated predominant expression of SP-A1 mRNA, whose expression was 17.4-fold higher in patients with PTD with chorioamnionitis ( n = 15) than in those without ( n = 13) ( p = 0.018). While no difference was observed in SP-A1 mRNA expression in the chorioamniotic membranes of women at term not in labour ( n = 16) and those in labour ( n = 14) ( p = 0.87), the expression in term membranes was higher than that of membranes from women with PTD without chorioamnionitis ( p = 0.003). Analysis of JAR choriocarcinoma cells demonstrated SP-A1 mRNA expression that was up-regulated following lipopolysaccharide treatment. Furthermore, monocytic cell lines (THP-1 and U937) and peripheral blood monocytes (CD14+/CD115+) obtained from pregnant women also expressed SP-A1 mRNA and protein, suggesting the presence of autocrine/paracrine activation in vivo. Interestingly, a mid-trimester amniotic fluid sample obtained from a case of tracheal atresia contained SP-A (3.13 µg/ml), indicating the presence of SP-A of extrapulmonary origin. These findings suggest not only that SP-A expression is a part of the innate immune response deployed during chorioamniotic inflammation, but also that chorioamniotic membranes are a source of SP-A in the amniotic fluid with advancing gestation. Copyright © 2007 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study examined the effects of a Web-based teaching method (versus a traditional lecture method) on undergraduate nursing students' learning of electrocardiography (ECG). The Web-based learning program was developed by the authors and implemented for 4 weeks. The study used a pretest-posttest experimental design. A total of 105 senior nursing students were recruited at a university in Korea. Fifty-four students were assigned to an experimental group in 2002, and 51 were assigned to a control group in 2003. Knowledge about ECG among students in the Web-based group was significantly lower than that of students in the control group (p < .01). Conversely, the ability to interpret ECG recordings was significantly higher among students in the Web-based group (p < .05). No significant differences were found between the two groups in level of motivation or satisfaction with learning. The self-directed, Web-based ECG learning program appears to be effective in helping nursing students to interpret ECG recordings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Soluble vascular endothelial growth factor receptor 1 (sVEGFR-1), which antagonizes VEGF functions, has been implicated in the pathophysiology of preeclampsia. The purpose of this study was to determine whether preeclampsia is associated with a change in the plasma concentration of sVEGFR-1, and, if so, whether such a change is correlated with the severity of the disease. METHODS: A cross-sectional study was conducted to determine the concentrations of sVEGFR-1 in plasma obtained from normal pregnant women (n=61) and patients with preeclampsia (n=61). Plasma concentrations of sVEGFR-1 were determined by enzyme-linked immunoassay. RESULTS: Preeclampsia had a higher median plasma concentration of sVEGFR-1 than normal pregnancy (P <.001). The median plasma concentration of sVEGFR-1 was higher in early-onset (< or =34 weeks) than late-onset (>34 weeks) preeclampsia (P=.005), and higher in severe than in mild preeclampsia (P=.002). In normal pregnancy, there was a correlation between plasma concentration of sVEGFR-1 and gestational age (r=0.5; P <.001). In contrast, there was a negative correlation between plasma concentration of sVEGFR-1 and gestational age at the onset of preeclampsia (r=-0.5; P <.001). CONCLUSION: Preeclampsia is associated with an increased plasma sVEGFR-1 concentration. The elevation of sVEGFR-1 concentration is correlated with the severity of the disease. These observations suggest the participation of VEGF and its soluble receptor in the pathophysiology of preeclampsia. [ABSTRACT FROM AUTHOR]

In order to enhance understanding of the quality of decision making during family planning consultations in developing countries, provider competencies and client behaviors during 179 randomly selected consultations in Indonesia were assessed. Results show that family planning clients make a significant contribution to the quality of the decision-making process, most notably by identifying the problem requiring a decision, expressing their feelings about using a method, and asking questions. Client involvement may compensate for provider weaknesses, which tend to be in areas calling for interpersonal rather than technical skills. However, the programmatic ideal of informed choice has not yet been realized. Supervisors, trainers, communicators, and program managers can improve the quality of decision making by: creating opportunities for client involvement during consultations, strengthening providers' ability to fully inform clients about their options, and making providers aware of the opportunities for decision making in consultations with continuing clients. [ABSTRACT FROM AUTHOR]

Paternalistic models of health care, social distance between patients and providers, and cultural norms discourage patients from playing an active role in health consultations. This study tested whether individual coaching can give family planning patients the confidence and communication skills to talk more openly and more vigorously with providers. Educators met with 384 Indonesian women in clinic waiting rooms and coached them on asking questions, expressing concerns, and seeking clarification. An analysis of audiotaped consultations found that patients who received coaching articulated significantly more questions and concerns than others. Coaching narrowed differentials in active communication by patient type, age, and assertiveness, but it widened differentials by patient education and socioeconomic class. The discontinuation rate at 8 months was lower in the intervention than the control condition, but the difference was only marginally significant. [ABSTRACT FROM AUTHOR]

Reduction and manipulation using percutaneously fixated Schanz screws and unreamed intramedullary nailing facilitates fracture reduction, promotes early weight bearing, and decreases complications such as nonunion, malalignment, in failure. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to compare surgical and survival outcomes of laparoscopic radical hysterectomy (LRH) vs open radical hysterectomy (ORH) in elderly patients with early-stage cervical cancer. STUDY DESIGN: A retrospective analysis was performed on elderly patients (>=65 years) who underwent either LRH (n = 99) or ORH (n = 159) due to stage IA2-IIA2 cervical cancer. RESULTS: One patient (1%) in LRH group required conversion to laparotomy. Operating time (P = .035), estimated blood loss (P = .002), recovery of bowel movement (P < .001), and postoperative hospital stay (P < .001) were significantly shorter or lower in LRH group. Postoperative complications were significantly less frequent in LRH group (P = .026). After the median follow-up time of 45 months, the 5-year disease-free survival (95% vs 93%, P = .350) and overall survival (96% vs 95%, P = .361) did not differ between LRH and ORH groups. CONCLUSION: Elderly patients tolerated well both LRH and ORH. LRH was associated with better surgical outcomes compared to ORH without increasing intraoperative complications or decreasing survival. [ABSTRACT FROM AUTHOR]

To present a method to classify health provider responses to patient cues and concerns according to the VR-CoDES-CC (Del Piccolo et al. (2009) [2] and Zimmermann et al. (submitted for publication) [3]). The system permits sequence analysis and a detailed description of how providers handle patient's expressions of emotion. [ABSTRACT FROM AUTHOR]

To present the Verona Coding Definitions of Emotional Sequences (VR-CoDES CC), a consensus based system for coding patient expressions of emotional distress in medical consultations, defined as Cues or Concerns. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: The methanol extract of Cimicifugae Rhizome has been traditionally used in various disorders including inflammation. Aim of the study: The aim of the study is to explore whether anti-inflammatory action of 3 active compounds, two triterpenoid glycosides (cimiside E, 23-O-actylshengmanol-3-xyloside) and one furanocoumarin (isoimperatorin), isolated from Cimicifugae Rhizome is related with peroxisome proliferator-activated receptor-γ (PPAR-γ) expression in human umbilical endothelial cell line, EA.hy926 cells. Materials and methods: Cell viability and production of reactive oxygen species were performed. In addition, adhesion of monocyte into endothelial cells and western blot for expression of adhesion molecules and signal proteins were investigated in tumor necrosis factor-α (TNF-α)-activated cells. Results: Pretreatment of test compounds significantly reduced reactive oxygen species (ROS) production and expression of vascular cell adhesion molecule-1 (VCAM-1), but not intercellular cell adhesion molecule-1 (ICAM-1). Three compounds all dose-dependently increased not only PPAR-γ expression in EA.hy926 cells but inhibited TNF-α-induced phosphorylation of Akt, extracelullar-signal-regulated kinase (ERK) and protein kinase C (PKC) with different specificity. Finally, they prevented TNF-α-induced adhesion of U937 monocytic cells to EA.hy926 cells. Conclusions: The present results show that cimiside E, 23-O-actylshengmanol-3-xyloside, isoimperatorin isolated from Cimicifugae Rhizome selectively inhibits TNF-α-induced expression of VCAM-1 at least by upregulation of PPAR-γ, and signals for ERK1/2, PI3K, and PKC are involved in this effect. [ABSTRACT FROM AUTHOR]