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Background Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. Methods We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized control trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. Results Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in IV group. Epidural group showed lower VAS than IV group at 12 hours (mean difference -0.99 [95% CI: -1.52, -0.47], P = 0.001, I2 = 0%), at 24 hours (mean difference -0.65 [95% CI: -1.15, -0.16], P = 0.009, I2 = 0%), and 48 hours (mean difference -0.81 [95% CI: -1.61, -0.01], P = 0.046, I2 = 46%) after the surgery. Conclusion Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia from 12 hours to 48 hours after surgery, and AUC of VAS was lower in the epidural group. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.

Background: Giant lip hemangioma is a rare disease that may cause difficulty in preoxygenation and ventilation when using face masks and intubation during general anesthesia induction.Case: A laparoscopic cholecystectomy was planned for a 77-year-old woman. The patient had a giant lower lip hemangioma that was 12 x 5 x 5 cm, which made preoxygenation and ventilation through a face mask impossible and put her at risk of hemangioma rupture. We preoxygenated her through a high-flow nasal cannula (HFNC). Following propofol and succinylcholine administration, we intubated the patient with a video laryngoscope without desaturation, hemangioma rupture, or CO2 retention. Conclusions: HFNC is a useful tool when difficult intubation is expected in patients who have problems using conventional face masks.

A 39-year-old pregnant patient with acute appendicitis was planned for emergency laparoscopic appendectomy in the second trimester of pregnancy. Preoperative two-dimensional transthoracic echocardiography revealed asymptomatic cor triatriatum sinisiter (CTS), dividing left atrium into two chambers. There was no associated cardiac anomaly, wall motion abnormality, or pulmonary hypertension. We report the case of a pregnant patient with CTS who uneventfully underwent laparoscopic appendectomy without invasive cardiac monitoring using total intravenous anesthesia.

Objective Frontonasal dysplasia (FND) is a rare congenital condition. Its major features include hypertelorism, a large and bifid nasal tip, and a broad nasal root. We present our technique of septal L-strut reconstruction using costal cartilage. Design Retrospective review from June 2008 and August 2017. Methods Under general anesthesia, 6 patients with FND underwent septal reconstruction using costal cartilage via open rhinoplasty. We reconstructed the nasal and septal cartilaginous framework by placing columellar struts and cantilever-type grafts. Results The patients ranged in age from 6 to 13 years old. All were female. The follow-up period ranged from 8 months to 2 years; we encountered no postoperative complications (infection, nasal obstruction, or recurrence). All patients were satisfied with their nasal appearance. Conclusions Although the results were not entirely satisfactory from an esthetic point of view, we found that FND can be treated via septal reconstruction with costal cartilage and that the clinical outcomes are reliable and satisfactory. Our approach is a useful option for FND patients.

There have been several reports of foreign bodies being discovered in the intravenous set. In this case, the patient complained that he found a worm in his intravenous line. It was later confirmed as a long, white fibrin deposit by pathologic examination. This happened even though there was a non-return valve in the intravenous line. Also, since there were few red blood cells in the deposit, it did not look like a blood clot. In cases like this, we suggest that physicians keep this possibility in mind to reassure their patients.

Primitive neuroectodermal tumor (PNET) arising primarily in the lung is an extremely rare and aggressive malignancy with poor chances of patient survival. We present a case of long-term survival by a 29-year-old woman with PNET diagnosed after a hertological and immunohertochemical examination of a biopsy specimen obtained by performing video-assisted thoracic surgery. The patient underwent a left lower lung lobe lobectomy and 6 cycles of adjuvant chemotherapy. The patient has been free of any symptoms of the recurrence of the disease for 6 years after treatment completion.

Bacterial vaginosis is a common female disease caused by a vaginal infection due to an overgrowth of bacteria that naturally live in the vaginal tract. Bacterial vaginosis has frequently been treated with the oral or vaginal administration of antibiotics and topical disinfectants. However, hygienic application of topical treatment deep in the vagina remains difficult. Herein, we introduce a novel vaginal cleaning device using plasma-activated water generated from supplied water. Remarkably, plasma source generation at atmospheric pressure is well known to eradicate bacterial infection through the generation of free radicals and/or chlorine chemicals with antimicrobial activity. The device was designed to alleviate a bacterial infection by spraying plasma-activated water generated from a cleaning solution container with plasma modules. The spray nozzle contains both a clean outlet and a suction outlet to spray and recover the plasma water, respectively, and is connected to a disposable silicone tube. The other nozzle, which has a laser light and air pump, can perform a second sterilization and dry the vagina after washing. Free chlorine chemicals with antibacterial activity were detected in the plasma-activated water by the device. Clinical application in patients with bacterial vaginosis confirmed the stability and effectiveness of our device. Therefore, these results show a novel clinical application of atmospheric pressure plasma to medical field as a plasma medicine.

Objectives To investigate the effect of the application of therapeutic hypothermia (32-35°C) on survival and major clinical endpoints in critically ill patients. Data sources We searched online database and clinical trial registries dated up to April 30, 2019, and references of relevant studies. Study selection Low risk of bias randomized trials which compared hypothermia applied for at least 24 hours and conventional therapy in critically ill patients were included. We excluded trials investigating therapeutic hypothermia in indications already supported by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns) or intraoperative hypothermia. Data extraction Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed, and data were abstracted using a structured template. Data synthesis Our search retained 14 low risk of bias randomized trials (2,670 patients) performed in three different settings: traumatic brain injury, serious infections, and stroke. Therapeutic hypothermia was associated with an increase in mortality at longest follow-up available (432/1,375 [31%] vs 330/1,295 [25%]; risk ratio, 1.24; 95% CI, 1.10-1.39; p = 0.0004; I = 0%). Pooled results showed no difference of good neurologic outcome among survivors between the two treatment arms (493/1,142 [43%] vs 486/1,067 [46%]; risk ratio, 1.04; 95% CI, 0.97-1.12; p = 0.27; I = 1%). Arrhythmias were significantly increased among patients undergoing therapeutic hypothermia. We found no difference between groups in pneumonia, serious infections, any infection, hemorrhage, renal failure, deep vein thrombosis, and uncontrollable intracranial hypertension. Conclusions High-quality randomized evidence indicates that therapeutic hypothermia is associated with higher mortality and no difference in good neurologic outcome compared with normothermia in critically ill patients. Although there still might be a possibility that therapeutic hypothermia is beneficial in a specific setting, routine application of therapeutic hypothermia would better be avoided outside the settings indicated by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns).

Dexmedetomidine (DXM) has anti-inflammatory effects, which is considered an important mechanism of DXM-induced neuroprotection from cerebral ischemia/reperfusion injury. We determined whether the anti-inflammatory effects of DXM are associated with inhibition of the toll-like receptor (TLR)-4/nuclear factor kappa B (NF-κB) pathway in a rat model of transient global cerebral ischemia/reperfusion injury. Fifty rats were randomly assigned to one of five groups (10 rats/group): Group S received no treatment; Group C underwent transient global ischemia (10min); Group D received DXM 30min before ischemia; Group R received resatorvid, a selective TLR-4 antagonist, 30min before ischemia; and Group RD received resatorvid and DXM 30min before ischemia. The numbers of necrotic and apoptotic cells and the levels of TLR-4, NF-κB, and caspase-3 were assessed 1day after ischemia, and pro-inflammatory cytokines including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) were measured before ischemia and 2, 6, and 24h thereafter. The necrotic and apoptotic cell counts and levels of TLR-4, NF-κB, and caspase-3 were higher in Group C than in other groups. TNF-α were higher in Group C than in other groups 2h after ischemia, whereas IL-6 were higher in Group C 6h after ischemia. IL-1β was higher in Group C than in Group D 6 and 24h after ischemia. Our findings suggest that the anti-inflammatory action of DXM via inactivation of the TLR-4/NF-κB pathway, in part, may explain DXM-induced neuroprotection after cerebral ischemia.

A 25-year-old male patient who was infected with human immunodeficiency virus (HIV) underwent a condyloma excision under spinal anesthesia. The patient complained of suspicious postdural puncture headache. The patient did not respond to conservative management. Subsequently, the subdural hematoma (SDH) was found through magnetic resonance imaging. In response, an epidural blood patch was used to improve the symptoms and inhibit the enlargement of the SDH. The patient was discharged after it was confirmed that a headache had subsided without increasing SDH. Anesthesiologist should be aware of other causes of headaches after spinal anesthesia in HIV-infected patients and should carefully and accurately identify the cause.

SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. Prompt diagnosis and therapeutic decisions regarding mechanical or pharmacologic support have to be made within a few minutes. In fact, a complex separation from CPB if not adequately treated leads to a poor outcome in the vast majority of cases. Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.

Purpose In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3-4, 5-6, and 7-8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8-96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression. Trial registration ClinicalTrials.gov Identifier: NCT01069211.

Pulmonary thromboembolism (PTE) is rarely reported in Behçet's disease (BD) due to its distinctive thrombus-forming mechanism. In BD, the inflammation on vessel walls causes venous thrombosis. The thrombi are considered to be tethered to the inflamed walls making embolization less frequent. Thus, immunosuppressive agents are the mainstay of treatment. However, the necessity of anticoagulation therapy is controversial because of its uncertain efficacy of resolving thrombi and the possibility of fatal side effects of hemorrhage. A 25-year-old man with recurrent oral aphthae visited with abrupt onset of dyspnea and chest pain. Based on history, imaging studies and laboratory results, he was diagnosed with BD with vascular involvement and antiphospholipid syndrome (APS), causing PTE from deep vein thrombosis. The co-existing APS may have further promoted the thrombosis, shifting his blood profile toward the hypercoagulable state. Immunosuppressive therapy with glucocorticoid and azathioprine, and concomitant anticoagulation with warfarin were achieved successfully without any fatal complications. When atypical features of vascular involvement in BD develop, other coexisting diseases should be considered to design an optimal therapeutic plan.

The RISPO (Remote Ischemic Preconditioning with Postconditioning Outcome) trial evaluated whether remote ischaemic preconditioning (RIPC) combined with remote ischaemic postconditioning (RIPostC) improves the clinical outcomes of patients undergoing cardiac surgery. This substudy of the RISPO trial aimed to evaluate the effect of RIPC with RIPostC on pulmonary function in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Sixty-five patients were enrolled (32: control and 33: RIPC-RIPostC). In the RIPC-RIPostC group, four cycles of 5min ischaemia and 5min reperfusion were administered before and after CPB to the upper limb. Peri-operative PaO2/FIO2 ratio, intra-operative pulmonary shunt, and dynamic and static lung compliance were determined.The mean PaO2/ FIO2 was significantly higher in the RIPC-RIPostC group at 24h after surgery [290 (96) vs. 387 (137), p=0.001]. The incidence of mechanical ventilation for longer than 48h was significantly higher in the control group (23% vs. 3%, p0.05). However, there were no significant differences in other pulmonary profiles, post-operative mechanical ventilation time, and duration of intensive care unit stay.In our study, RIPC-RIPostC improved the post-operative 24h PaO2/FIO2 ratio. Remote ischaemic preconditioning-Remote ischaemic postconditioning has limited and delayed pulmonary protective effects in cardiac surgery patients with CPB.

Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.

Objective The aim of this study was to determine whether or not perioperative administration of sodium bicarbonate had a preventive effect on cardiac surgery-associated acute kidney injury (CSA-AKI) as shown in randomized controlled trials. Design The authors conducted a systematic review and meta-analysis using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. Setting The authors searched MEDLINE, EMBASE, CENTRAL, and KoreaMed without language and date restrictions. They used both MeSH and free-text terms to identify relevant studies. Electronic searches were undertaken on July 31, 2014. Participants Five randomized controlled studies included in this review. Measurements and Main Results There were no differences in the development of CSA-AKI among patients in the sodium bicarbonate group compared with those in the control group (5 trials, 1,092 patients; n = 233 of 547 in sodium bicarbonate (SB) group versus 225 of 545 in control group (SC); risk ratio (RR), 0.95; 95% confidence interval (CI), 0.74-1.22. Also, there were no statistical differences in in-hospital mortality (3 trials, 573 patients; n = 21 of 288 in SB versus 14 of 285 in SC; RR, 1.44; 95% CI, 0.76-2.72), need for renal replacement therapy (4 trials, 1,000 patients; n = 21 of 503 in SB versus 23 of 497 in SC; RR, 0.90; 95% CI, 0.50-1.60), length of stay in the intensive care unit (ICU) (hours) (4 trials, n = 969 patients, weighted men difference (WMD), 2.17; 95% CI, -1.15-5.49), and length of ventilation (hours) (4 trials, 969 patients; WMD, 0.34; 95% CI,−0.80-1.48). Conclusions Perioperative administration of sodium bicarbonate did not reduce the rate of CSA-AKI in randomized controlled trials. Therefore, use of perioperative administration of sodium bicarbonate for the prevention of CSA-AKI is questionable.

Background/Aims: In the ABC classification system, group A consists of seronegative subjects without gastric corpus atrophy. This study aimed to determine the prevalence and characteristics of pseudo group A subjects. Methods: Group A subjects were identified among consecutive Korean adults who underwent a serum anti-Helicobacter pylori immunoglobulin G (IgG) test and pepsinogen (PG) assay on the day of endoscopy. Past infection was defined as the presence of either eradication history or endoscopic findings suggesting past infection (i.e., gastric xanthoma, metaplastic gastritis, or advanced atrophy >closed-type 1). Results: Among 2,620 group A subjects, 448 (17.1%) had eradication history, and 133 (5.1%) showed endoscopic findings suggesting past infection. Older age (odds ratio [OR], 1.148; 95% confidence interval [CI], 1.067 to 1.236) and earlier year of birth (OR, 1.086; 95% CI, 1.009 to 1.168) were independent risk factors for classification into pseudo group A, with cutoff points at 50.5 years and birth year of 1959.5, respectively. Positive H. pylori test findings were found in 22 subjects (3.1%) among the 715 subjects who underwent the urea breath test or Giemsa staining on the same day. Current infection was positively correlated with PG I and PG II levels (p

Background Incomplete sesamoid reduction is a potential risk factor for the recurrence of hallux valgus. The purpose of this study was to radiologically investigate changes in sesamoid position after chevron osteotomy and the open lateral soft tissue procedure. Methods Sixty-eight feet that underwent operative correction for hallux valgus deformity were reviewed consecutively. The hallux valgus angle (HVA), first to second intermetatarsal angle (IMA), tibial sesamoid position (TSP), distance of the fibular sesamoid (DFS), and translation of the metatarsal head (TMH) were evaluated preoperatively and at final follow-up. Results While most parameters were significantly decreased after surgery, no significant change in DFS (correction − 1.45 mm, p = 0.08) was noted. The difference between preoperative and postoperative TSP values (ΔTSP) has a moderately positive correlation with difference in TMH values (ΔTMH) (Rho 0.475, p = .000). Other parameters were similarly correlated. Conclusions First, metatarsal bone realignment reduced the sesamoid, but its position, relative to the second metatarsal axis (DFS), was unchanged. The sesamoid is reduced by the lateral translation of the first metatarsal but not by medial sesamoid migration.

// Jin-Ock Kim 1 , So-Ra Kim 1 , Key-Hwan Lim 1 , Jun-Hyun Kim 1 , Brijesh Ajjappala 1 , Hey-Jin Lee 1 , Jee-In Choi 2 , Kwang-Hyun Baek 1 1 Department of Biomedical Science, CHA University, Bundang CHA Hospital, Gyeonggi-Do 463-400, Republic of Korea 2 Department of Rehabilitation Medicine, CHA University, Bundang CHA Hospital, Gyeonggi-Do 463-400, Republic of Korea Correspondence to: Kwang-Hyun Baek, e-mail: baek@cha.ac.kr Keywords: 14-3-3, cell proliferation, deubiquitinating enzyme, ubiquitin-specific protease Received: May 27, 2015 Accepted: September 14, 2015 Published: September 25, 2015 ABSTRACT 14-3-3 is a family of highly conserved protein that is involved in a number of cellular processes. In this study, we identified that the high expression of 14-3-3γ in various cancer cell lines correlates with the invasiveness of the cancer cells. Overexpression of 14-3-3γ causes changes to the morphologic characteristics of cell transformation, and promotes cell migration and invasion. The cells overexpressed with 14-3-3γ have been shown to stimulate foci and tumor formation in SCID-NOD mice in concert with signaling components as reported with the 14-3-3β. In our previous study, we demonstrated that 14-3-3γ inhibits apoptotic cell death and mediates the promotion of cell proliferation in immune cell lines. Earlier, binding partners for 14-3-3γ were defined by screening. We found that USP37, one of deubiquitinating enzymes (DUBs), belongs to this binding partner group. Therefore, we investigated whether 14-3-3γ mediates proliferation in cancer cells, and 14-3-3γ by USP37 is responsible for promoting cell proliferation. Importantly, we found that USP37 regulates the stability of ubiquitin-conjugated 14-3-3γ through its catalytic activity. This result implies that the interactive behavior between USP37 and 14-3-3γ could be involved in the regulation of 14-3-3γ degradation. When all these findings are considered together, USP37 is shown to be a specific DUB that prevents 14-3-3γ degradation, which may contribute to malignant transformation via MAPK signaling pathway, possibly providing a new target for therapeutic objectives of cancer.

The isolated body lateropulsion has been well recognized in caudal lateral medullary infarction and postulated to result from the involvement of ipsilateral dorsal spinocerebellar tract which is known to convey proprioception of trunk and legs. However, there has been no case accompanied by the tilt of the subjective visual vertical in caudal lateral medullary infarction. Recently, it has been suggested that a lesion in the ipsilateral graviceptive vestibulothalamic pathway can lead to alteration of subjective visual vertical without ocular tilt reaction in various brainstem lesions. Here we describe two cases of caudal lateral medullary infarction with ipsilesional body lateropulsion and subjective visual vertical tilt but without limb ataxia or ocular tilt reaction. It could be hypothesized that the ascending graviceptive information from the spinal cord may run adjacent to the dorsal spinocerebellar tract or perception of the visual vertical can be influenced by ascending spinal proprioception.

Shoshin beriberi is a fulminant form of cardiac beriberi caused by thiamine deficiency. We report on a case of an 87-year-old man with shoshin beriberi presenting as cardiogenic shock with diffuse ST-segment elevation, which dramatically improved after thiamine administration. Because of the rarity of the occurrence, lack of diagnostic test and atypical presentation, diagnosing shoshin beriberi is challenging and requires a high index of clinical suspicion. Shoshin beriberi leads to rapid haemodynamic collapse and death. Therefore, clinicians should consider shoshin beriberi (or cardiac beriberi) as one of the differential diagnoses in patients with heart failure or cardiogenic shock.

The combination chemotherapy of irinotecan with 5-fluorouracil and leucovorin (FOLFIRI regimen) was recently proven to be beneficial in patients with advanced colorectal cancer. Pulmonary toxicity is very rare in adverse effects of irinotecan. No case of organizing pneumonia (also known as bronchiolitis obliterans organizing pneumonia) associated with FOLFIRI chemotherapy has been reported. We experienced a case of a 62-year-old man who presented persistent dry cough and progressive dyspnea after receiving chemotherapy with FOLFIRI regimen. After surgical lung biopsy, the patient was diagnosed with FOLFIRI chemotherapy-induced organizing pneumonia which was successfully treated with steroid therapy.

Background:Childhood obesity and its comorbidities have become major public health challenges in the US. While previous studies have investigated the roles of land uses and transportation infrastructure on obesity, limited research has examined the influence of landscape spatial patterns. The purpose of this study was to examine the association between landscape spatial patterns and obesity in Hispanic children.Methods:Participants included 61 fourth- and fifth-grade Hispanic children from inner-city neighborhoods in Houston, TX. BMI z-scores were computed based on objectively-measured height and weight from each child. Parental and child surveys provided sociodemographic and physical activity data. Landscape indices were used to measure the quality of landscape spatial patterns surrounding each child’s home by utilizing Geographic Information Systems and remote sensing analyses using aerial photo images.Results:After controlling for sociodemographic factors, in the half-mile airline buffer, more tree patches and well-connected landscape patterns were negatively correlated with their BMI z-scores. Furthermore, larger sizes of urban forests and tree patches were negatively associated with children’s BMI z-scores in the half-mile network buffer assessment.Conclusions:This study suggests that urban greenery requires further attention in studies aimed at identifying environmental features that reduce childhood obesity.

Peroneal nerve palsy can be caused by various etiology. We report unilateral peroneal nerve palsy after compression stockings application. A 64-year-old man underwent off-pump coronary bypass graft. Surgeon did not use saphenous vein for the bypass graft. Sedation was stopped after 3 h postoperative. After 16 h, for prophylaxis of deep vein thrombosis, knee-high elastic stocking was applied. After 1 h, he took off right stocking because of numbness but left stocking was kept. After 24 h postoperative, (8 h after stocking application) patient complained suddenly left foot drop. Manual muscle test revealed 0/5 of ankle dorsiflexion, ankle eversion, and toe extension. Sensory was decreased to 70% in lower half of anterolateral aspect of tibia, foot dorsum, and toes. Foot drop and sensory abnormality decreased in 3 weeks. Cardiac surgery patients already have many risk factors for peripheral neuropathy. Clinicians should be careful when applying stockings on those patients.

Despite intense efforts, the cure rates of childhood and adult solid tumors are not satisfactory. Resistance to intensive chemotherapy is common, and targets for molecular therapies are largely undefined. We have now found that the majority of childhood solid tumors, including rhabdoid tumors, neuroblastoma, medulloblastoma and Ewing sarcoma, express an active DNA transposasePGBD5that can promote site-specific genomic rearrangements in human cells. Using functional genetic approaches, we found that mouse and human cells deficient in non-homologous end joining (NHEJ) DNA repair cannot tolerate the expression of PGBD5. In a chemical screen of DNA damage signaling inhibitors, we identified AZD6738 as a specific sensitizer of PGBD5-dependent DNA damage and apoptosis. We found that expression of PGBD5, but not its nuclease activity-deficient mutant, was sufficient to induce hypersensitivity to AZD6738. Depletion of endogenous PGBD5 conferred resistance to AZD6738 in human tumor cells. PGBD5-expressing tumor cells accumulated unrepaired DNA damage in response to AZD6738 treatment, and underwent apoptosis in both dividing and G1 phase cells in the absence of immediate DNA replication stress. Accordingly, AZD6738 exhibited nanomolar potency against the majority of neuroblastoma, medulloblastoma, Ewing sarcoma and rhabdoid tumor cells tested, while sparing non-transformed human and mouse embryonic fibroblastsin vitro. Finally, treatment with AZD6738 induced apoptosis and regression of human neuroblastoma and medulloblastoma tumors engrafted in immunodeficient micein vivo. This effect was potentiated by combined treatment with cisplatin, including significant anti-tumor activity against patient-derived primary neuroblastoma xenografts. These findings delineate a therapeutically actionable synthetic dependency induced in PGBD5-expressing solid tumors.

Carotid intima-media thickness (IMT) is a surrogate marker for evaluating atherosclerotic vascular diseases. The phosphodiesterase inhibitor cilostazol attenuates the increase in carotid IMT in diabetes patients. We studied whether cilostazol can reduce the progression of carotid IMT in symptomatic ischemic stroke patients. From our prospective registry of acute ischemic stroke patients who were admitted during a 4.5-year period, follow-up carotid ultrasound was performed in a random sample of survivors. Patients were divided into two groups: the cilostazol group, who continued cilostazol treatment during the follow-up period; and the control group, who were prescribed antiplatelets other than cilostazol. Analysis of covariance and propensity score-matched analysis were used to evaluate the difference between groups. Among a total of 1,049 cases in our registry, 208 patients were utilized to construct two comparable sets by propensity score analysis, including 101 who received cilostazol and 107 who took antiplatelet medication without cilostazol. Both maximum and mean carotid IMT values were significantly reduced in the cilostazol group but increased in the control group (maximum left –0.048 ± 0.186 vs. 0.022 ± 0.163 mm, p = 0.001; maximum right –0.037 ± 0.173 vs. 0.050 ± 0.200 mm, p = 0.001; mean left –0.052 ± 0.102 vs. 0.023 ± 0.112 mm, p

Uncontrolled proliferation is one of the hallmarks of breast cancer. We have previously identified the human Ecd protein (human ortholog of Drosophila Ecdysoneless, hereafter called Ecd) as a novel promoter of mammalian cell cycle progression, a function related to its ability to remove the repressive effects of Rb-family tumor suppressors on E2F transcription factors. Given the frequent dysregulation of cell cycle regulatory components in human cancer, we used immunohistochemistry of paraffin-embedded tissues to examine Ecd expression in normal breast tissue versus tissues representing increasing breast cancer progression. Initial studies of a smaller cohort without outcomes information showed that Ecd expression was barely detectable in normal breast tissue and in hyperplasia of breast, but high levels of Ecd were detected in benign breast hyperplasia, ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDCs) of the breast. In this cohort of 104 IDC patients, Ecd expression levels showed a positive correlation with higher grade (P = 0.04). Further analyses of Ecd expression using a larger, independent cohort (954) confirmed these results, with a strong positive correlation of elevated Ecd expression with higher histological grade (P = 0.013), mitotic index (P = 0.032), and Nottingham Prognostic Index score (P = 0.014). Ecd expression was positively associated with HER2/neu (P = 0.002) overexpression, a known marker of poor prognosis in breast cancer. Significantly, increased Ecd expression showed a strong positive association with shorter breast cancer specific survival (BCSS) (P = 0.008) and disease-free survival (DFS) (P = 0.003) in HER2/neu overexpressing patients. Taken together, our results reveal Ecd as a novel marker for breast cancer progression and show that levels of Ecd expression predict poorer survival in Her2/neu overexpressing breast cancer patients. Electronic supplementary material The online version of this article (doi:10.1007/s10549-011-1946-8) contains supplementary material, which is available to authorized users.

A 76-year-old male patient was admitted for mitral valvuloplasty. He had suffered a myocardial infarction 7 months earlier, and two stents had been inserted in the left main coronary artery and left circumflex artery. Intraoperative transesophageal echocardiography revealed a 10 × 8 mm echogenic mass at the ostium of the left main coronary artery. We initially suspected severe atheromatous calcification at the coronary ostium, which might require aortotomy and removal, but we decided to perform an epiaortic ultrasonographic scan first to obtain better images and reevaluate. Epiaortic scanning with a linear sonographic probe identified the mass as a protruding coronary stent. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 43:135–137, 2015

BACKGROUND Helicobacter pylori is unevenly distributed in hypochlorhydric environments. The study aim was to elucidate the risk factors for a negative Giemsa staining finding in seropositive subjects by measuring the secretory ability of the stomach. METHODS Subjects aged over 18 years were included consecutively after endoscopic biopsy at gastric lesions with color or structural changes. Blood was sampled for the serum pepsinogen (PG) assay and H. pylori serology test. After excluding the subjects with past H. pylori eradication, the risk factors for a negative Giemsa staining finding in seropositive subjects were analyzed. RESULTS Among 872 included subjects, a discrepancy between the serum anti-H. pylori IgG and Giemsa staining findings was found in 158 (18.1%) subjects, including 145 Giemsa-negative, seropositive subjects. Gastric adenocarcinoma/adenoma (OR = 11.090, 95% CI = 3.490-35.236) and low serum PG II level (OR = 0.931, 95% CI = 0.899-0.963) were the independent risk factors for a negative Giemsa staining finding in seropositive subjects. The cutoff value of serum PG II level was 7.45 ng/mL (area under curve [AUC] = 0.904, 95% CI = 0.881-0.927). Follow-up studies of Giemsa staining at different sites of the stomach revealed that 75% of the Giemsa-negative seropositive subjects with adenocarcinoma are positive, whereas none of those with low serum PG II level of

We report a healthy patient with postpartum headache and neck stiffness which were diagnosed as symptoms of pseudoaneurysm of vertebral artery. She had received a Cesarean section under the spinal anesthesia, and complaint of headache and neck stiffness. Epidural blood patches were done twice, but symptoms persisted. Eight days later, she experienced sensory disturbance and emergent laminectomy was done. When persistent postpartum headache occurs after epidural blood patch, more precise differential diagnosis should be made and considering other possible pathologies.

Electronic supplementary material The online version of this article (doi: 10.1007/s10072-016-2593-y ) contains supplementary material, which is available to authorized users.

Epiglottic cysts sometimes compromise a patient's airway, and may make airway management difficult. We report a novel method of intubating a patient with a large epiglottic cyst, using direct laryngoscopy and a light wand. A 53-year-old man with hoarseness was admitted to the hospital. He complained of a mild cough and sore throat for 2 days, without dyspnea. General anesthesia for microscopic laser surgery was planned. Neck computed tomography revealed a nearly non-enhancing cyst, 2.7 × 1.8 × 3.3 cm, located on the right prelingual surface of the epiglottis (Figs. 1A and 1B). Fig. 1 Neck computed tomography (CT) revealed a nearly non-enhancing cyst in the right pre-epiglottic space with concomitant mild airway obstruction ([A] Transverse and [B] Sagittal views). (C) This image shows direct laryngoscope, light wand and laser tube ... In addition to standard monitoring and preparations, we prepared laryngeal mask airways, adult and pediatric fiberoptic bronchoscopes, and an emergency cricothyrotomy kit at the bedside. Two attending anesthesiologists and one resident were present in the operating room. After preoxygenation, propofol 120 mg was given. The patient became unconscious, and we confirmed there was no difficulty with mask ventilation. We then administered rocuronium 25 mg intravenously. After 4 minutes, we attempted intubation with a Macintosh blade no. 3 and 5.0 laser tube (Laser-Flex® Tracheal Tube, Mallinckrodt, St. Louis, MO, USA) without stylet. We carefully placed the tip of the Macintosh blade at the vallecula, avoiding direct pressure on the cyst. After that, an assistant held the handle of the laryngoscope steady. The intubating anesthesiologist then held the hockey stick-shaped light wand in the left hand and used it both for leverage and as a light source. Gently elevating both the epiglottis and cyst with the light wand in the upper left direction revealed the lower third of the glottis with sufficient light. We then intubated the patient. After intubation, we began mechanical ventilation with air. Tidal volume was set to 500 ml, respiration rate was 12 per minute, and peak airway pressure was 26 cmH2O. Anesthesia was maintained with sevoflurane 1.5-2.0 vol% and remifentanil continuous infusion of 0.1-2.0 mcg/kg/min. Oxygen saturation was maintained at a minimum of 95% throughout the surgery and in the recovery room. The patient recovered and was discharged after 1 day without any adverse events. Most epiglottic cysts are located on the lingual surface or vallecula, which makes intubation difficult, when a cyst is large. For the treatment of epiglottic cysts, simple aspiration of the cyst results in frequent recurrence, so complete removal is recommended [1]. For this removal, laser surgery seems to be superior to cold instrument surgery, in many respects. During laser surgery, the use of laser resistant endotracheal tubes is recommended to avoid catastrophic airway fires. There are several choices for laser resistant endotracheal tubes, including wrapping metal foil around conventional tubes, Xomed Laser-Shield (Laser-Shield®II Endotracheal Tube, Medtronic Xomed, Jacksonville, FL, USA), and Mallinckrodt Laser-Flex. Inevitably, methods or tubes such as these are accompanied by an increase in the wall thickness of the tubes. With the Laser-Flex, for example, the outer diameter (OD) of the tubes is at least 2.5 mm greater than the internal diameter (ID). This number is considerable in comparison to the thickness of conventional tubes, which is 1.3 mm at minimum. In our case, when intubation was attempted, the epiglottic cyst blocked the light from the laryngoscope, so structures behind the cyst were not visible (Fig. 1C). To circumvent this problem, there are several possible options. First, we could use a Miller blade or a Magill blade. Holding the epiglottis from the lower surface, together with the cyst, may allow direct visualization of the vocal cords without blockage of the light. However, considering the size of the cyst, this maneuver might fail. In addition pressure of the blade may rupture the cyst and cause pulmonary aspiration of its contents. Second, we could aspirate the contents of the cyst and then try the conventional intubation method. If the mass was not entirely cystic, or lobulated, the chances of success would be slim. Furthermore, attempting aspiration without first securing the airway may significantly increase the risk of pulmonary aspiration of cyst contents. Lastly, we could choose larger diameter tubes to use a light wand, intubating stylet, or fiberoptic bronchoscope. For airway surgery, though, it is rational to choose the smallest tubes possible to facilitate the surgery. We chose an ID 5.0 Laser tube, the OD of which is equivalent to the OD of an ID 5.5 conventional tube. The OD of an adult fiberoptic bronchoscope used for awake intubation is 5.0 mm, the same as the ID of the Laser tube. The OD of a light wand is 5.55 mm, still larger than the ID of the tube. The OD of the intubating stylet was 4.65 mm, but due to small differences between the ID of the tube and the OD of the stylet, using it was impossible. In patients with more difficult airways, it may be rational to choose a Laser-Flex tube with a bigger ID and use a stylet in it, but this also may be difficult because of the dimmed light caused by the cyst. A light wand may still be difficult to use because of the large OD of a light wand for an ID 6.0 Laser tube. The difference in diameter between the two is only 0.45 mm. Laser tubes are rigid and difficult to use with a fiberoptic bronchoscope. In addition, to use an adult bronchoscope, one must use a tube with an ID larger than 6.0 mm. A McCoy blade can be helpful in some situations. In our case it might be effective, but considering the size and the location of the cyst, even elevating the epiglottis might not make it possible to move the cyst away from the light source. In actuality, levering of the epiglottis in the ventral and cranial direction would move the cyst closer to the light source and might make the view dimmer. Using a fiberoptic bronchoscope or light wand in the presence of a large epiglottic cyst is also a difficulty, because of the mass blocking the passage. Recently, Choi et al. [2] reported a case of intubation of a patient with a large glottic mass. In their report, introducing a flexible bronchoscope was difficult and ultimately not possible, in spite of attempts at guidance and visualization with the GlideScope® (Verathon Inc., Bothell, WA, USA) video laryngoscope. The authors did not report the size of the mass in their case, but the picture included in their report shows similarity to our case. Epiglottic cysts poses great challenges for anesthesiologists in some cases. Our method can be a relatively easy, less invasive, simple method dealing with some large epiglottic cysts.

Primary lung adenoid cystic carcinoma (ACC) is extremely rare and accounts for approximately 0.1%-0.2% of all lung cancers. ACC of the head and neck has generally been regarded as a slow-growing, low-grade malignancy which has a tendency for local recurrence and frequent distant metastasis. When ACC of the lung is identified, physicians must determine whether it represents distant metastasis or a primary lung cancer. Thyroid transcription factor-1 staining is one of the most useful methods to differentiate primary from metastatic lesions in lung cancer. Herein we report a case of metachronous, not synchronous, ACC at the peripheral lung followed by ACC presentation at the base of the tongue, and review of relevant literatures.

Aorta-right atrial tunnel (ARAT), first reported in 1980 by Coto, is a rare congenital vascular anomaly. A 36-year-old female was admitted with chest discomfort, dyspnoea, palpitations, and general weakness. She had been treated for rheumatic fever at the age of 10, with no sequelae. Physical exam was normal except a grade 3/6 continuous murmur at the right sternal border. Transthoracic echocardiography (TTE) showed a tunnel-like shape …

Uric acid (UA) has been known to be a neuroprotective antioxidant because of its free radical scavenger activity. We studied the influence of UA in patients with acute ischemic stroke after thrombolytic therapy. Two hundred eighteen consecutive patients treated with intravenous thrombolysis were included in this analysis. We analyzed the relationship between serum UA levels obtained at the emergency department and clinical outcomes. Early improvement and excellent functional outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS) 24 h after onset and the modified Rankin scale after 3 months. There was no significant relationship between serum UA levels and early improvement or excellent functional outcome in the total patients (p = 0.583 and p = 0.082, respectively). However, in patients with severe baseline stroke deficits (NIHSS score ≥15), higher-tertile UA levels were significantly associated with excellent functional outcomes (p = 0.003). Excellent functional outcomes in patients with severe baseline disability might have a significant association with serum UA levels particularly in men but not in women (p = 0.007 in men and p = 0.621 in women). Increased serum UA levels might be associated with better outcomes in ischemic stroke patients treated with intravenous thrombolysis, but the effectiveness of UA can differ by initial stroke severity and gender.

Although a substantial body of literature has provided evidence supporting the positive effects of natural environments on well-being, little has been known about the specific spatial patterns of urban nature in promoting health-related quality of life (HRQOL) among children. This study assessed the association that the urban natural environment measured by landscape spatial patterns may have with obesity and HRQOL among Hispanic children. Ninety-two 4th and 5th grade students were recruited from Houston, Texas, and the Pediatric Quality of Life Inventory (PedsQL) was used to capture the children's HRQOL. The quality of urban natural environments was assessed by quantifying the landscape spatial patterns, using landscape indices generated by Geographic Information Systems and remote sensing. From the bivariate analyses, children's body mass index showed a significantly negative association with their HRQOL. After controlling for socio-demographic factors, the results revealed that larger and more tree areas were positively correlated with children's HRQOL. In addition, those children living in areas with tree patches further apart from each other showed higher HRQOL. This research adds to the current multi-disciplinary area of research on environment-health relationships by investigating the roles of urban greeneries and linking their spatial structures with children's HRQOL.

Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, chronic oligoanovulation and insulin resistance. A number of women with PCOS are obese and exhibit abnormal phenotypes, including high levels of androgens, an irregular menstrual cycle and increased hair growth. Studies on obese PCOS patients have proven the crucial role that obesity plays in insulin resistance and hyperinsulinemia. The uncoupling protein (UCP) gene is one of the genes known to have a strong association with obesity and insulin resistance. Thus, we analyzed the association between the -866G/A polymorphism in the promoter of UCP2 and PCOS. Genotyping was performed by polymerase chain reaction along with restriction fragment length polymorphism analysis, followed by an analysis of the genotype of the UCP2 polymorphism in PCOS and control subjects using HapAnalyzer. The study included samples from 277 PCOS patients and 152 healthy controls. P

Cryptogenic organizing pneumonia (COP) is an inflammatory lung disease involving the distal bronchioles, respiratory bronchioles, bronchiolar ducts, and alveolae. The etiology is usually unknown; however, there are several known causes and associated systemic diseases. Corticosteroid therapy is the best treatment option and the prognosis of COP is good, with recovery in up to 80% of patients. We described a patient with in-operable hepatocellular carcinoma (HCC) undergoing chemoembolization with doxorubicin in a drug-eluting bead (DEB). COP developed in the patient after chemoembolization but resolved spontaneously in several months.

Background The described clinical characteristics of early-onset Alzheimer’s disease (EOAD) are distinct from that of late-onset AD. We reported a patient with atypical EOAD. Case Report A 54-year-old, truck driver developed gradual visuospatial, language and calculation deficits for 3 months. The neuropsycho logical impairments were extensive. Brain MRI revealed asymmetric atrophy in left medial temporal lobe along with distinct widening of syl vian fissure. (18)F-florbetapir-positron emission tomography (PET) showed a high uptake in the cortex. Further, the profiles of cerebrospinal fluid (CSF) biomarker were compatible with AD. Conclusions We diagnosed the patient as EOAD based on the result of biomarker study. Increased As burden was identified through am yloid PET imaging and decreased CSF Aβ level. The high rise of CSF Tau proteins was in agreement with the patient’s extensive and rapid cognitive decline. This case report demonstrates the importance of AD biomarker study in confronting early-onset dementia with atypical clinical presentation.

Rupture limited to the lobar bronchus from blunt trauma is especially rare, and the symptoms are light so diagnosis is difficult. In a patient who visited the hospital complaining of shortness of breath after falling down, atelectasis continued in the chest x-ray. Four days after visiting the hospital, a left upper lobar bronchial rupture was diagnosed through a bronchoscopy and 3 dimensional chest computerized tomography. When diagnosis is delayed in the case of a rupture limited to the lobar bronchus, bronchial obstruction can occur from the formation of granulation tissue, so regular monitoring is important. Therefore, when atelectasis continues after blunt trauma, it is important to differentially diagnose a lobar bronchial rupture through tests such as bronchoscopy.

Left atrial dissection does occur, though rarely, after mitral valve surgery. A 68-year-old Korean female presented with moderate mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation and mild aortic regurgitation. She was scheduled for mitral valve replacement and tricuspid annuloplasty. We experienced a left atrial dissection after weaning from cardiopulmonary bypass and decided not to repair it. The patient recovered uneventfully. We suggest that a specific type of left atrial dissection can be treated conservatively.

Electrocardiography (ECG) is an essential monitoring method that provides important information related to cardiac physiology. However, the sinus rhythm can be interpreted as a serious arrhythmia, such as ventricular tachycardia (VT), due to artifacts [1]. We present a case in which a VT-like artifact appeared on an ECG during a total thyroidectomy. A 33-year-old female was admitted for a thyroidectomy due to hyperthyroidism. There were no significant findings on a pre-operational examination, including thyroid function test. The ECG showed a normal sinus rhythm. The thyroid was significantly enlarged overall; the sizes of the right lobe, isthmus, and left lobe were 7 × 3 × 3 cm, 5 × 1.5 × 1 cm, and 6.5 × 3.5 × 2 cm, respectively. Initial vital signs were blood pressure (BP) of 120/70 mmHg, pulse rate (PR) of 70 /min, body temperature of 36.5℃, and SaO2 of 98%. ECG leads were attached to both infraspinatus muscle area and lateral side of left 4th rib. Anesthesia was induced with propofol, rocuronium and remifentanil. After the endotracheal intubation, anesthesia maintained with sevoflurane, remifentanil. An electrocautery grounding pad was attached to the left peroneal posterior surface, and electrical noise was not observed. The surgery proceeded, but 170 minutes into the operation, when the operator retracted the upper pole for dissection, the PR increased to above 190 /min with a VT-like ECG rhythm. At that time, BP was 110/70 mmHg. We asked for an immediate suspension of surgery and identified it as an arrhythmia related to thyroid disease. Esmolol 30 mg was administered, and then amiodarone and direct current cardioversion were prepared to address the VT. Immediately after the administration, the PR fell to within the normal range of 70-80 /min and normal QRS rhythm was restored. However, a similar manifestation on the ECG and tachycardia were seen 15 minutes later on the same surgical procedure. At that time, the patient presented a BP of 103/63 mmHg, PR of 74 /min, and normal pulse oximeter wave was observed. On analyzing the ECG rhythm strip printed from the monitor, the hidden QRS wave was found within the waveform suspected as artifacts (Fig. 1). The surgery was continued without further treatment, and completed without any problem. The patient presented a stable hemodynamic status and clear consciousness, and discharged on day 7 post-operation. Fig. 1 Rhythm strips on both events. It relevantly showing notch sign (arrow) and spike sign (bold arrow). ECG artifacts can be classified into two main groups: physiological and nonphysiological artifacts. Some causes of physiological artifacts include muscular activity and the movement of patients [2]. Narrow, rapid, and spiky electromyographic signals may present on the ECG due to muscular activity, but these signals are mostly filtered by recent ECG monitors. Artifacts due to movement result from the ECG electrode being attached to the patient's skin; as it actively generates the potential difference between the interior and exterior of the skin. Stretching the skin changes the degree of skin potential, which can cause various artifacts on the ECG [3]. Epidermal stretch-induced voltage changes are the primary cause of motion artifacts, and such artifacts are not filtered [2]. In our case, a VT-like abnormal rhythm appeared on the ECG when the operator was conducting traction and dissection at the upper pole of the thyroid. Therefore, an epidermal stretch-induced voltage change due to the traction of the skin during traction of the huge thyroid can not be ruled out as causing the artifact. Common causes for nonphysiological artifacts include insufficient electrode gel or contamination of the electrode by betadine [2]. However, there is a low possibility of the abnormal signal being caused by insufficient gel or contamination, because the abnormal ECG was presented in the middle of surgery and a protective film was applied to prevent electrode contamination. While using monopolar electrocauterization, a faulty ground or electrical noise input may be another cause of nonphysiological artifacts. In this case, the electrocauterizer grounding pad was attached to the left peroneal surface, and there was no abnormal manifestation on the ECG at cauterization prior to the occurrence of the abnormal rhythm; hence, there is a low possibility of artifact due to these factors. Also, thyrotoxic crisis could be a possibility. However, although there was an increase in the heartbeat on ECG, at that time BP was normal; this situation differs from thyrotoxic crisis, where systolic hypertension under a high-output state with a widening of pulse pressure is observed. Furthermore, as most of the thyroid gland was dissected, there is a low possibility that an abrupt input of thyroid hormone into the blood vessel could have caused VT. Huang et al. [4] suggested a diagnostic algorithm for pseudo-VT caused by a tremor-induced artifact. For a suspected manifestation of VT on ECG, pseudo-VT can be diagnosed when one of the following signs is observed: "sinus sign", where the sinus rhythm and normal P, QRS, and T wave are observed in a single limb lead (leads I, II, III); "spike sign", where a regular or irregular tiny spike is observed on the QRS complex; and "notch sign", where a notch is observed on the QRS-like complex with sinus rhythm cycle. In this case, the spike sign and notch sign were observed, and pseudo-VT caused by an artifact was diagnosed accordingly. Arrhythmia during anesthesia is a frequently experienced manifestation. Especially, VT may cause a serious hemodynamic abnormality, immediate diagnosis and treatment are important. However, a normal rhythm can be construed as a serious arrhythmia due to the artifact. Therefore, it is crucial to consider the possibility of unnecessary and potentially fatal treatment at all times. Srikureja et al. [5] reported that artifacts as a causative factor always should be taken into account when a hemodynamically stable, asymptomatic patient presents with an abnormality on the ECG and confirmation of each lead on 12-lead ECG at the time of the episode, and checking the basic pulse. In conclusion, when suspecting arrhythmia during anesthesia, it is essential to confirm the uniform occurrence of arrhythmia on other confirmable leads, and the diagnostic approach should include collecting clinical evidences such as the wave form on the pulse oximeter, PR and BP at the time of the event.

Breast cancer is the most common type of cancer and second leading cause of cancer-related deaths in women in the United States. Our laboratory has identified the protein hEcd (human ortholog of Drosophila Ecdysoneless) as a novel regulator of cell cycle. Previous studies showed that Ecd regulates cell cycle by regulating the Rb-E2F pathway. Given the dysregulation of the cell cycle machinery in cancer, we examined expression of Ecd in normal, benign, ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDCs) of breast. In first cohort, we showed while normal and hyperplasia of breast barely showed Ecd expression, high Ecd expression was observed in DCIS and IDC patient tissue specimens. In this cohort of 104 IDC patents, Ecd expression was positively associated with higher grade (p=0.04).We then analyzed Ecd expression in a second larger cohort (954) and observed similar results, where increased Ecd expression was associated with tumors of higher histological grade (p=0.013), mitotic count (p=0.032), and Nottingham Prognostic Index score (p=0.014). Notably, Ecd expression was positively associated with HER2/neu (p=0.002) overexpression. Significantly, a positive association between Ecd expression and shorter breast cancer specific survival (BCSS) (p=0.008) and disease-free survival (DFS) (p=0.003) was observed in HER2/neu overexpressing patients. Taken together, our results demonstrate Ecd expression as a novel marker for breast cancer progression that predicts tumor progression and the clinical outcome in breast cancer patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4593. doi:1538-7445.AM2012-4593

Purpose Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. Methods We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. Results The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. Conclusion Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

Mounier-Kuhn-syndrome patients have markedly dilated trachea and main bronchi due to an atrophy or absence of elastic fibers and thinning of smooth muscle layers in the tracheobronchial tree. Although this syndrome is rare, airway management is challenging and general anesthesia may produce fatal results. However, only a few cases have been reported and this condition is not widely known among anesthesiologists. We present the case of a tracheobronchomegaly patient undergoing an emergency off-pump coronary artery bypass. Although the trachea was markedly dilated with numerous tracheal diverticuli, there was an undilated 2 cm portion below the vocal cords found on the preoperative CT. Under a preparation of extracorporeal membrane oxygenation, we intubated and placed the balloon of an endotracheal tube (I.D. 9 mm) at this portion, and maintained ventilation during the operation. This case showed that a precise preoperative evaluation and anesthetic plan is essential for successful anesthetic management.

Purpose: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea Methods: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. Results: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.78.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. Conclusions: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.