Transnasal endoscope-assisted endoscopic submucosal dissection for gastric adenoma and early gastric cancer in the pyloric area: a case series

Endoscopic submucosal dissection (ESD) is an important therapeutic option for gastric adenoma and early gastric cancer (EGC). However, ESD is technically difficult when lesions are located in the pyloric area. Our aim was to introduce the transnasal endoscope-assisted ESD method, which provides for excellent cutting-line visualization through control of submucosal traction. A total of eight patients with gastric adenoma or EGC located in the pyloric area were consecutively enrolled. A primary operating endoscope was used to perform marking, incision, submucosal dissection, and hemostasis, while a thinner, transnasal endoscope operated by a second endoscopist was used to retract connective submucosal tissue to provide cutting-line visualization using V-shaped grasping forceps. En bloc resection was achieved in all eight cases, as was complete resection. The median longest lesion diameter was 19 mm (range: 12-25 mm), and the median procedure time was 37.5 minutes (range: 29-59 minutes). There were no incidents of significant bleeding or perforation. Transnasal endoscope-assisted ESD was useful for treating gastric neoplasms in the pyloric area. The procedure was relatively easy and safe, provided excellent visualization through tissue retraction, and allowed for complete en bloc resection.

Clinical evaluation of DFN3 patients with deletions in the POU3F4 locus and detection of carrier female using MLPA

X-linked deafness type 3 (DFN3), the most prevalent X-linked form of hereditary deafness, is caused by mutations of the POU3F4 locus in the Xq21 region. We evaluated two Korean families showing typical characteristics of DFN3, such as congenital hearing loss and pathognomonic inner ear anomalies. Genetic analysis of these families did not reveal any mutations in the POU3F4 coding sequence. Instead, one family carried a genomic deletion upstream of POU3F4 gene, where the regulatory element is predicted to reside, and the other family possessed a deletion of almost the entire Xq21 region. The lack of mutation in the POU3F4 coding sequence makes the detection of carrier females using conventional sequencing methods difficult. By applying the multiplex ligation-dependent probe amplification (MLPA) method, we successfully determined the carrier status of female members in these families, demonstrating that MLPA is a rapid and accurate way to detect POU3F4 deletions in sporadic undiagnosed carriers of DNF3.

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2 weighted and PET/CT imaging

OBJECTIVES

To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T(2) weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer.

METHODS

50 consecutive patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. All patients underwent 3.0 T rectal MRI and PET/CT after completing CRT. For qualitative analysis, two radiologists independently reviewed T2WI alone and DWI with T2WI over a 1-month interval. One nuclear medicine physician reviewed PET/CT images using a five-point scale. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting viable tumour were assessed. For quantitative analysis, the apparent diffusion coefficients (ADCs) of the lesions were measured and compared between the viable tumour group and non-viable tumour groups.

RESULTS

For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90%; Reviewer 2, 86%) over T2WI alone (Reviewer 1 detected 76%, p=0.5; Reviewer 2, 64%, p=0.013) or PET/CT (48%, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98%; Reviewer 2, 91%) was significantly higher than those of T2WI alone (Reviewer 1 detected 77%; Reviewer 2, 64%) or PET-CT (43%, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43%) significantly different from that of PET/CT (17%, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 × 10(-3) mm(2) sc(-1)) was significantly lower than that of the non-viable tumour group (1.55 × 10(-3) mm(2) sc(-1), p<0.0001).

CONCLUSION

Adding DWI to T2WI is helpful for detecting viable tumours after neoadjuvant CRT compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer.

Effect of potential multimicrobe probiotic product processed by high drying temperature and antibiotic on performance of weanling pigs

In this study, the effect of a potential multimicrobe probiotic subjected to high-temperature drying was investigated. Potential multimicrobe probiotics produced by solid substrate fermentation were dried at low (LT, 40°C for 72 h) or high (HT, 70°C for 36 h) temperature. In Exp. 1, 288 weaned pigs (BW, 6.43 ± 0.68 kg) were allotted to 4 treatments on the basis of BW (4 pens per treatment with 18 pigs in each pen). Dietary treatments were negative control (NC; basal diet without any antimicrobial), positive control (PC; basal diet + 0.1% chlortetracycline), basal diet with 0.3% probiotic LT, and basal diet with 0.3% probiotic HT. Diets were fed in 2 phases, phase I (d 0 to 14) and phase II (d 15 to 28); and growth performance, apparent total tract digestibility (ATTD, d 28), and fecal microflora (d 14 and 28) were evaluated. Over the 28-d trial, pigs fed PC and probiotic diets had greater ADG (P < 0.001), ADFI (P < 0.05), and G:F (P < 0.01) than pigs fed NC diet. The ATTD of DM and GE was greater (P < 0.05) in pigs fed probiotic diets when compared with pigs fed the NC diet. At d 28, fewer Clostridia (P < 0.01) were identified in the feces of pigs fed PC and probiotic diets than pigs fed the NC diet. However, the performance, ATTD of DM and GE, and fecal Clostridia population were similar among pigs fed probiotic LT and HT diets. In Exp. 2, 288 weaned pigs (initial BW, 5.84 ± 0.18 kg) were allotted to 4 treatments in a 2 × 2 factorial arrangement on the basis of BW. The effects of 2 levels of probiotic HT (0.30 or 0.60%), each with or without antibiotic (chlortetracycline, 0 or 0.1%), on performance, ATTD, intestinal morphology, and fecal and intestinal microflora were investigated. Feeding of 0.60% probiotic HT diet improved (P < 0.05) overall ADG, ATTD of DM and GE, and Lactobacillus population in the feces and intestine, and reduced the population of Clostridium and coliforms in feces (d 14) and ileum. Inclusion of antibiotic improved (P < 0.05) the overall ADG, ADFI, and ATTD of DM at d 14 and reduced fecal Clostridium population at d 28. Increased (P < 0.05) villus height at jejunum and ileum, and villus height:crypt depth at the ileum was noticed in pigs fed 0.60% probiotic HT and antibiotic diets. In conclusion, high drying temperature had no effect on the efficacy of potential multimicrobe probiotic product. However, the probiotic product dried at high temperature was more effective at 0.60% inclusion, whereas inclusion of an antibiotic improved pig performance but did not show any interaction with probiotics.

Biologic characteristics of bone marrow-derived mesenchymal stem cells from a patient with thalassemia syndrome

INTRODUCTION

Mesenchymal stem cells (MSCs) are capable of self-renewal and differentiating morphologically and functionally into several mesenchymal tissues. There have been contrasting data on whether MSCs are altered in various hematologic disorders.

METHODS

We isolated bone marrow (BM)-derived MSCs from a patient with thalassemia syndrome to compare phenotypic and functional characteristics to those from normal healthy donor.

RESULTS

No differences were observed between MSCs from thalassemia syndrome (T-MSCs) and those from normal healthy donor in terms of morphology, phenotype, karyotype, multidifferentiation capacity. In mixed lymphocyte reaction, T-MSCs strongly inhibited the proliferation of allogeneic T cells in association with reduced proportion of CD3(+), CD4(+), and CD8(+) cells. Furthermore, the fraction of Treg cells was increased under the culture with T-MSCs, suggesting that T-MSCs exert normal immunomodulatory function. In addition, T-MSCs expressed hematopoietic cytokines and supported hematopoiesis, which was comparable to those from normal BM-derived MSCs.

CONCLUSION

T-MSCs exhibited normal phenotype, karyotype as well as normal immunomodulatory function, and autologous MSCs from patients with thalassemia syndrome may be an attractive source of stem cell in terms of hematopoietic support as well as immunomodulatory activity.

Characterization of congenital lymphatic and blood vascular malformations in the head and neck using blood pool scintigraphy and spect

The purpose of this study was to investigate the usefulness and diagnostic efficacy of blood pool (BP) scintigraphy and SPECT for characterizing congenital vascular malformations (CVMs) in the head and neck area. A total of 154 patients suspected of having head and neck CVMs underwent whole-body BP scintigraphy and head and neck BP SPECT using 99mTc-labeled red blood cells. Based on SPECT findings, CVMs were classified into lymphatic malformation/ non-(blood) vascular disease (LM/NVD, no distinct uptake), arterio-venous malformation (AVM, abnormal uptake in lesions and asymmetrically increased jugular vein uptake on ipsilateral side), venous malformation (VM, strong uptake in lesions with symmetric jugular vein uptake), and veno-lymphatic malformation (VLM, no or mild uptake on lesions with symmetric jugular vein uptake). The sensitivities and specificities of BP SPECT for diagnosing each subtype of head and neck CVM were 100% (13/13) and 97.1% (137/141) for LM/NVD, 61.1% (22/36) and 99.1% (117/118)for AVM, 91.7% (88/96) and 79.3% (46/58) for VM, and 55.6% (5/9) and 93.7% (136/145) in VLM, respectively. The overall accuracy for characterizing CVMs by head and neck BP SPECT was 83.1% (128/154). In conclusion, BP SPECT is a useful method for classifying CVMs in the head and neck area due to its high diagnostic efficacy.

Functional analysis and molecular characterization of two acetylcholinesterases from the German cockroach, Blattella germanica

Two acetylcholinesterases (AChEs; BgAChE1 and BgAChE2) from Blattella germanica were functionally expressed using the baculovirus system. Kinetic analysis demonstrated that BgAChE2 had higher catalytic efficiency but lower substrate specificity than BgAChE1. With the exceptions of paraoxon and propoxur, BgAChE1 was generally less sensitive to inhibitors than BgAChE2. Western blot analysis using anti-BgAChE antibodies revealed that BgAChE1 was far more abundant in all examined tissues compared to BgAChE2, which is only present in the central nervous system. Both BgAChEs existed in dimeric form, covalently connected via a disulphide bridge under native conditions. Most fractions of BgAChE1 had a glycophosphatidylinositol (GPI) anchor, but a small fraction comprised a collagen-like tail. BgAChE2 appeared to have a collagen-GPI-fused tail. Based on the kinetic and molecular properties, tissue distribution and abundance, BgAChE1 was confirmed to play a major role in postsynaptic transmission.

Polymorphisms in the Matrilin-1 gene and risk of mandibular prognathism in Koreans

Previous linkage analysis of an Asian population proposed possible candidate genes for mandibular prognathism, such as Matrilin-1 (cartilage matrix protein). To investigate the association between the single-nucleotide polymorphisms (SNPs) in Matrilin-1 and mandibular prognathism, we investigated three sequence variants (-158 T>C, 7987 G>A, 8572 C>T) in 164 mandibular prognathism patients and 132 control individuals with a normal occlusion. The results showed that the 8572 TT genotypes in Matrilin-1 showed increased risk of mandibular prognathism (OR = 9.28, 95% Cl = 1.19~197.57, P < 0.05), whereas the 7987 AA genotype showed a protective effect for mandibular prognathism (OR = 0.16, 95% Cl = 0.05~0.47, P < 0.05). Genotyping results showed that the Matrilin-1 polymorphism haplotype TGC (ht4; 158T, 7987G, and 8572C alleles) had a pronounced risk effect for mandibular prognathism compared with controls (OR = 5.16, 95% Cl = 2.03~13.93, P < 0.01). The results suggest that polymorphisms in Matrilin-1 could be used as a marker for genetic susceptibility to mandibular prognathism.

Suppression of tumor growth in xenograft model mice by programmed cell death 4 gene delivery using folate-PEG-baculovirus

Cancer gene therapy using tumor suppressor genes is considered to be an attractive approach for arresting cell growth and inducing apoptosis. Programmed cell death 4 (Pdcd4) is a tumor suppressor gene, which prevents tumorigenesis and tumor progression. To address the issue of whether expression of PDCD4 protein induces apoptosis in cancerous cells, the Pdcd4 gene was delivered using folate-PEG-baculovirus. Folate-PEG-baculovirus containing Pdcd4 gene (F-P-Bac-Pdcd4) was constructed by attachment of F-PEG to the baculovirus surface using chemical modification. The F-P-Bac-Pdcd4 showed enhanced transduction efficiency, efficiently expressed PDCD4 protein, and induced apoptosis in human epidermal carcinoma (KB) cells as compared with an unmodified baculovirus. In a tumor xenograft study, injection of F-P-Bac-Pdcd4 into tumors established from the KB cell line by subcutaneous implantation significantly suppressed tumor growth and induced apoptosis. Thus, this study shows a new baculovirus-mediated tumor suppressor gene delivery system for cancer therapy.

Effects of green tea extract administration on the pharmacokinetics of clozapine in rats

The pharmacokinetic interaction between clozapine, an atypical antipsychotic with metabolic complications, including weight gain, and green tea consumption has not been evaluated, although green tea is responsible for beneficial effects, including weight reduction, and is widely consumed in the world. Commercial green tea extract (175 mg kg−1) or saline was administered orally for 4 days before the oral administration of clozapine (20 mg kg−1) to rats. Plasma concentrations of clozapine were measured up to 5 h after clozapine administration, and then hepatic CYP1A2 expression and activity were determined. There was no significant difference in the elimination half-life of clozapine between the green tea extract and saline groups. However, the time to reach peak concentration (Tmax) was significantly increased by green tea extract. The mean total area under the plasma concentration-time curve (AUC0-∞) and maximal peak plasma concentration (Cmax) of clozapine in the green tea extract group were significantly lower than those of controls. Green tea extract induced a ∼2-fold increase in hepatic CYP1A2 levels, while the activity increased slightly (by 10% of control). Because of this reduction in AUC and Tmax of clozapine by green tea extract pretreatment, we suggest that both the rate and amount of absorption of clozapine may be reduced by green tea extract, although the hepatic elimination phase may not be significantly altered. Therefore, the clinical implications of the effects of green tea on the bioavailability of clozapine in patients should be further evaluated.

Benefit of downsizing hepatocellular carcinoma in a liver transplant population

BACKGROUND

Long-term results after downstaging hepatocellular carcinoma (HCC) prior to liver transplantation (LT) remain unknown.

AIMS

To investigate dropouts and post-transplant outcome among patients with downstaged HCC by transarterial chemo-lipiodolization (TACL).

METHODS

Between 2000 and 2007, 386 patients with HCC initially exceeding Milan criteria underwent TACL for tumour downstaging and were consecutively enrolled.

RESULTS

Overall, 160 (41.5%) patients achieved successful downstaging of HCC to within Milan criteria. During the follow-up, 82 eventually dropped off the waiting list for LT, with estimated dropout rates at 1, 2 and 5 years of 46.7%, 70.2%, and 87.2%, respectively. The overall post-transplant survival rates at 1, 2 and 5 years were 89.2%, 70.3% and 54.6% and the corresponding rates for recurrence-free survival were 74.7%, 71.8% and 66.3% respectively. Multivariate analysis indentified alpha-fetoprotein (AFP) levels > or = 100 ng/mL at LT (P = 0.003), maximum tumour size > or = 7 cm (P = 0.002) and the lack of complete necrosis by TACL (P = 0.048) as independent predictors of HCC recurrence after LT. Patients with none of these risk factors had an excellent post-transplant outcome, with an 87.5% probability of recurrence-free survival up to 6 years.

CONCLUSIONS

These long-term results may contribute to the database for optimizing management of LT candidates with downstaged HCC. Based on our data, patients with a maximum tumour size <7 cm who achieve complete necrosis together with AFP levels <100 ng/mL at LT may be the best candidates for LT following downstaging using TACL.

Impact of posterior communicating artery on basilar artery steno-occlusive disease

BACKGROUND

Acute brainstem infarction with basilar artery (BA) occlusive disease is the most fatal type of all ischaemic strokes. This report investigates the prognostic impact of the posterior communicating artery (PcoA) and whether its anatomy is a safeguard or not.

METHODS

Consecutive patients who had acute brainstem infarction with at least 50% stenosis of BA upon CT angiography (CTA) were studied. The configuration of PcoA was divided into two groups upon CTA: "textbook" group (invisible PcoA with good P1 and P2 segment) and "fetal-variant of PcoA" group (only visible PcoA with absent P1 segment). Baseline demographics, radiological findings and stroke mechanisms were analysed. A multiple regression analysis was performed to predict clinical outcome at 30 days (modified Rankin disability Scale (mRS<or=2)).

RESULTS

Among all 95 patients, 58% (n = 55) had good prognoses (mRS<or=2). Interestingly, 44 patients (46.3%) had at least one fetal-variant PcoA (26 bilateral, 18 unilateral). By multiple logistic regression analysis, the atherosclerotic mechanism (OR 18.0; 95% CI 3.0 to 107.0) and presence of fetal-variant PcoA (OR 5.1; 95% CI 1.4 to 18.8) were independent predictors for good prognosis and initial NIH stroke scale score (OR 1.24 per one-point increase; 95% CI 1.1 to 1.4) for poor prognosis.

CONCLUSIONS

Fetal-variant PcoA appears to act as a safeguard against ischaemic insult in acute stroke victims involving the brainstem with BA occlusive disease. This result can be explained by the fact that patients with fetal-variant PcoA have a smaller area of posterior circulation and a possibility of retrograde filling into the upper brainstem through the fetal-variant PcoA.

Deferred modification of antiretroviral regimen following documented treatment failure in Asia: results from the TREAT Asia HIV Observational Database (TAHOD)

OBJECTIVE

The aim of the study was to examine the rates and predictors of treatment modification following combination antiretroviral therapy (cART) failure in Asian patients with HIV enrolled in the TREAT Asia HIV Observational Database (TAHOD).

METHODS

Treatment failure (immunological, virological and clinical) was defined by World Health Organization criteria. Countries were categorized as high or low income by World Bank criteria.

RESULTS

Among 2446 patients who initiated cART, 447 were documented to have developed treatment failure over 5697 person-years (7.8 per 100 person-years). A total of 253 patients changed at least one drug after failure (51.6 per 100 person-years). There was no difference between patients from high- and low-income countries [adjusted hazard ratio (HR) 1.02; P=0.891]. Advanced disease stage [Centers for Disease Control and Prevention (CDC) category C vs. A; adjusted HR 1.38, P=0.040], a lower CD4 count (>or=51 cells/microL vs. <or=50 cells/microL; adjusted HR 0.61, P=0.022) and a higher HIV viral load (>or=400 HIV-1 RNA copies/mL vs. <400 copies/mL; adjusted HR 2.69, P<0.001) were associated with a higher rate of treatment modification after failure. Compared with patients from low-income countries, patients from high-income countries were more likely to change two or more drugs (67%vs. 49%; P=0.009) and to change to a protease-inhibitor-containing regimen (48%vs. 16%; P<0.001).

CONCLUSIONS

In a cohort of Asian patients with HIV infection, nearly half remained on the failing regimen in the first year following documented treatment failure. This deferred modification is likely to have negative implications for accumulation of drug resistance and response to second-line treatment. There is a need to scale up the availability of second-line regimens and virological monitoring in this region.

Early energy and protein reduction: effects on growth, blood profiles and expression of genes related to protein and fat metabolism in broilers

1. A total of 320-d-old Ross broilers were used in a 6-week study to investigate the effects of feeding lower energy and protein diets from d 8 to 14 on growth performance, blood profiles, and gene expression of leptin and myostatin. 2. Broilers were randomly allotted to 4 treatments, each treatment applied to 4 pens with 20 birds in each. During first week, all the birds were fed on a common starter diet (13.4 MJ ME/kg, 230 g/kg CP and 11.0 g/kg lysine). The birds were then subjected to their respective treatment diets from d 8 to 14. Treatment diets comprised two ME levels, 13.4 and 12.0 MJ/kg, each with two levels of CP, 230 and 184 g/kg. This was followed by feeding common starter and finisher diets for the last 4 weeks. 3. Dietary protein reduction resulted in poor performance and feed efficiency while energy reduction resulted in poor feed efficiency between d 8 and 14. From d 14 to 42 birds previously fed diets lower in energy and protein showed similar body weight gain and feed intake to well-fed birds. Moreover from d 8 to 14, birds fed on energy and protein-reduced diets had lower nutrient metabolisability coefficients. 4. The blood urea nitrogen (BUN) and relative weights of heart and breast muscle were lower in birds fed protein-reduced diets while energy reduction resulted in lower plasma glucose, abdominal fat and intestinal weight at d 14. At d 42, birds fed on the protein-reduced diets had lower BUN, breast muscle weight and small intestine length, while feeding on the energy-reduced diets resulted in lower abdominal fat. 5. Upregulated myostatin mRNA expression in breast muscle and downregulation of leptin mRNA expression in abdominal fat were observed in birds fed on protein and energy-reduced diets, respectively. 6. In conclusion, early nutrient reduction affected growth performance and produced lesser abdominal fat in broilers. Moreover, early energy and/or protein reduction could change muscle and fat metabolism by regulating the expressions of myostatin and leptin.

Characterization of congenital vascular malformation in the extremities using whole body blood pool scintigraphy and lymphscintigraphy

The purpose of this study was to investigate the clinical usefulness of combined whole body blood pool scintigraphy (WBBPS) and lymphscintigraphy (LS) in the characterization of patients with congenital vascular malformations (CVMs) of the extremities. Subjects included 134 patients who underwent Tc-99m RBC WBBPS and Tc-99m filtered tin colloid (or antimony sulfur colloid) LS on initial diagnosis. Scintigraphic results were interpreted as arteriovenous malformations (AVMs), venolymphatic malformations (VLMs), lymphatic malformations (LMs), and venous malformations (VMs). Final diagnosis of the type of vascular malformation was determined by physical examination, magnetic resonance imaging (MRI), angiography, duplex ultrasonography, and/or biopsy results. The final diagnosis demonstrated that 14 of the study subjects had an AVM, 29 had a HLM, 20 had a LM, and 71 had a VM. The sensitivity of WBBPS and LS in the characterization of CVM was 85.7% (12/14) for AVMs, 96.6% (28/29) for VLMs, 95.0% (19/20) for LMs, and 88.7% (63/71) for VMs. The specificity was 100% for AVMs (120/120), 91.4% for VLMs (96/105), 99.1% for LMs (113/114), and 98.4% for VMs (62/63). The overall accuracy of WBBPS and LS was 91.0% (122/134). Our results show that combination of WBBPS with LS can characterize extremity CVMs in patients with high diagnostic accuracy, and may thus be useful for making optimal treatment decisions.

Effects of metabolizable energy and lysine restrictions on growth performance, blood profiles, and expression of myostatin and leptin genes in broilers

To investigate the effects of metabolizable energy and lysine restriction on performance, and gene expression of leptin and myostatin, three hundred twenty day-old Ross broiler chicks were randomly allotted to four treatments. Birds were subjected to their respective diets comprising two levels of ME (3200; 2880 kcal kg-1) and two levels of lysine (1.10; 0.88%) during days 8 to 21. The dietary crude protein levels were reduced with the proportion to the lysine levels, while ratios of essential amino acids relative to lysine were similar for all diets. During restriction, weight gain, breast muscle and abdominal fat yield were lower in birds fed lysine-restricted diets. Relative myostatin mRNA abundance was increased in breast muscle of lysine-restricted birds, while expression of leptin mRNA in abdominal fat was downregulated by energy and lysine restriction. During realimentation, birds previously fed with energy and/or lysine-restricted diets had comparable performance as birds fed unrestricted diets. At day 42, energy and lysine restriction increased relative myostatin mRNA expression in breast muscle and birds previously fed diet restricted in both energy and lysine had the highest relative myostatin mRNA expression (energy × lysine interaction, P < 0.001). The relative leptin mRNA abundance was significantly lower in birds previously fed energy-restricted diets. These results indicated that early energy and lysine restriction from day 8 to 21 exhibited growth compensation during realimentation. In addition, myostatin and leptin mRNA expression in breast muscle and abdominal fat were modulated by nutritional treatments and were closely associated with changes in breast muscle yield and abdominal fat deposition. Key words: Metabolizable energy, lysine, myostatin, leptin, broiler

The land use plan and water quality prediction for the Saemangeum reclamation project

As the final closure of the world's longest sea dike of 33 km, the use of the Saemangeum reclaimed land becomes an issue in Korea. The Korean government has proclaimed that the Saemangeum Reclamation Project will be handled in an environmentally friendly manner but its effect on the water quality of reservoirs has always been controversial. This study was conducted to estimate the water quality of the Saemangeum reservoir using WASP5 according to the new land use plan adopted in 2007. Predictions on water quality shows that Dongjin reservoir would meet the standards for COD, T-P, and Chl-a if the wastewater from the Dongjin region was properly managed. However, T-P and Chl-a in Mangyeong reservoir would exceed the standards even without releasing the treated wastewater into the reservoir. With further reductions of 20% for T-P and Chl-a from the mouth of Mangyeong river, the water quality standards in the reservoir were achieved. This means that additional schemes, as well as water quality management programs established in the Government Master Plan in 2001, should be considered. Although the Saemangeum reservoir would manage to achieve the standards, it will enter a eutrophic state due to the high concentration of nutrients.

Infectious complications in living-donor liver transplant recipients: a 9-year single-center experience

BACKGROUND

Infectious complications following living-donor liver transplantation (LDLT) remain a major cause of morbidity and mortality. We analyzed the frequency and type of infectious complications according to the post-transplantation period, and their risk factors with regard to morbidity and mortality.

METHODS

We retrospectively analyzed 208 subjects who had undergone LDLT during a 9-year period.

RESULTS

The rate of infection was 1.69 per patient during the study period. The predominant infections were intra-abdominal infections (37.6%), primary bacteremia (17.4%), and pneumonia (14.5%). Within the first post-transplant month, 140 (39.9%) infections were detected, and catheter-related coagulase-negative staphylococci (44) were the most common infectious agents. During the 2-6-month post-transplant period, 109 infectious episodes occurred (31.1%), and Enterococcus sp. (n=16) related to biliary infection was the most frequent isolate. After the sixth month, 96 infectious episodes (29%) occurred, and biliary tract-related Escherichia coli (n=19) was the major causative organism. The overall mortality was 24.5% (51/208); 1-year survival rate was 88% (196/208). Post-transplant infection-related mortality was 52.9% (27/51). Biliary tract complications, such as biliary stenosis or leakage, significantly increased the mortality (P=0.01); however, reoperation (retransplantation or resurgery for biliary tract obstruction/leakage or to control bleeding) significantly reduced the mortality (P=0.01).

CONCLUSIONS

Our data showed that early catheter removal would mainly aid in reducing infectious complications in the 1-month post-transplantation period. Aggressive management, including reoperation, would lower the mortality in the LDLT recipients.

Effects of lysine intake during late gestation and lactation on blood metabolites, hormones, milk composition and reproductive performance in primiparous and multiparous sows

Modern genotype primiparous and multiparous sows (Yorkshire x Landrace, n=48) were used to evaluate effects of dietary lysine intake during late gestation and lactation, and their interaction on reproductive performance. Sows were randomly allotted to two gestation lysine (G, 0.6% or 0.8% lysine) treatments based on parity in a 2 x 2 factorial arrangement, and each treatment had 12 replicates comprising 1 sow. Then all the sows were assigned to two lactation lysine (L, 1.0% or 1.3% lysine) treatments within parity and gestation treatments in a 2 x 2 x 2 factorial design, and each treatment comprised six replicates with 1 sow/replicate during lactation. Feeding higher lysine level during gestation increased sow body weight and backfat thickness (P=0.001) and body condition was better (P=0.001) in multiparous than that of primiparous sows. Both of the lysine levels during lactation and parity influenced sow body condition and reproductive performance (P<0.05). Higher lysine intake during lactation increased the concentrations of total solids (P=0.024), protein (P=0.001) and solids not-fat (P=0.042) in colostrum and total solids (P=0.001), protein (P=0.001), fat (P=0.001) and solids not-fat (P=0.005) in milk. Protein concentration of milk was greater (P=0.001) in multiparous sows than that of primiparous sows. Feeding of high lysine diets resulted in an increment of plasma urea N (P=0.010; P=0.047) and a decrease of creatinine (P=0.045; P=0.002) on the day of postfarrowing and weaning, respectively. Furthermore, as lysine intake increased, the secretions of insulin, FSH, and LH were increased (P<0.05) and multiparous sows showed higher (P<0.05) concentrations of FSH and LH pulses on the day of postfarrowing and weaning, respectively. These results indicated that higher lysine intake than that recommended by NRC [NRC, 1998. Nutrient Requirements of Swine, 10th ed. National Academy Press, 458 Washington, DC] could improve sow performance during late gestation and lactation. Furthermore primiparous sows need higher lysine intake than multiparous sows. Moreover, nutritional impacts on reproduction may be mediated in part through associated effects on circulating LH concentration.

Potato (Solanum tuberosum L. cv. Gogu valley) protein as a novel antimicrobial agent in weanling pigs

A total of 280 weaned pigs (Landrace x Yorkshire x Duroc) were used in a 28-d growth study to investigate the effect of feeding different levels of potato proteins on growth performance, nutrient digestibility, immune response, small intestinal morphology, and bacterial populations in feces and large intestine. Pigs (initially 6.42 +/- 0.74 kg of BW and 23 +/- 3 d of age) were randomly allotted to 5 treatments on the basis of BW, each treatment composed of 4 pens, each pen having 14 pigs. Dietary treatments included positive control (PC; basal diet + 150 mg/kg apramycin and 10 mg/ kg colistin sulfate); and potato protein (PP), consisting of the basal diet with 0, 0.25, 0.50, or 0.75% of potato protein. Diets were fed in 2 phases: phase I (d 0 to 14 postweaning) and phase 2 (d 14 to 28 postweaning). Potato protein was extracted from a value-added type of the new potato variety, Solanum tuberosum L. cv. Gogu valley, and was shown to have a minimum inhibitory concentration of 300 to 500 mug/mL. Performance of PC was compared with 0.25 to 0.75% PP, whereas linear and quadratic trends of increasing PP (0 to 0.75% PP) were tested. Over the 28-d trial, pigs fed the PC diets showed improved overall ADG (P < 0.05) and G:F (P = 0.090) compared with pigs fed PP, whereas increasing levels of PP linearly improved ADG (P < 0.05), ADFI (P = 0.052), and G:F (P = 0.098). The digestibility of DM and CP in both the phases was greater in PC than PP, and feeding of PP linearly improved the DM digestibility (P < 0.05) in phase II. The bacterial populations in the feces of pigs fed PC and PP were comparable, except for total bacteria and coliform bacteria in the feces at d 14 and 28, which were decreased in PC; and feeding of PP was effective in linearly reducing the populations of microbes in feces and contents of cecum, colon, and rectum. There was linear increase (P < 0.10) in skin-fold thickness in response to phytohemagglutinin with an increase in PP levels. Haemagglutinin titers on d 21 were greater (P = 0.054) in PC, and at d 28 the haemagglutinin titers were quadratically affected in pigs fed PP (P = 0.070). There was a trend toward a decrease in crypt depth (P = 0.068) and a greater villus height:crypt depth ratio (P = 0.082) of ileum in PC compared with PP. These results suggest that PP may be an alternative to medicated feed with antibiotics because it showed antimicrobial activity by effectively reducing the population of coliform bacteria and also improved the performance of weanling pigs.

Lymphscintigraphy predicts response to complex physical therapy in patients with early stage extremity lymphedema

We investigated whether baseline lymphscintigraphic findings can predict long-term response to complex physical therapy (CPT) in patients with early stage extremity lymphedema. Twenty patients with unilateral extremity lymphedema of clinical stage I or II underwent CPT after baseline lymphscintigraphy. Therapeutic responses (good vs. poor) were evaluated at 1 year post-CPT based on changes in skin status and subjective symptoms, and percent volume reductions and compared with clinical factors and lymphscintigraphic findings. Eleven patients showed good response to CPT with significant volume reduction of edematous extremities, and no significant volume reduction was observed in the remaining 9. Patients with good or poor responses to CPT showed no significant differences in terms of clinical variables. However, significant differences were observed between the lymphscintigraphic findings of these patients. More specifically, a lymphscintigraphic finding of main lymphatic vessels without collateral lymphatic vessels was the best predictor for a good response to CPT; the sensitivity, specificity and accuracy of this lymphscintigraphic finding is 91% (10/11), 100% (9/9) and 95% (19/20), respectively. In patients with unilateral extremity lymphedema of early stage, baseline lymphscintigraphy may usefully predict long-term response to CPT.

Molecular and functional expression of anion exchangers in cultured normal human nasal epithelial cells

Aims

Anions have an important role in the regulation of airway surface liquid (ASL) volume, viscosity and pH. However, functional localization and regulation of anion exchangers (AEs) have not been clearly described. The aim of this study was to investigate the regulation of AE mRNA expression level in accordance with mucociliary differentiation and the functional expression of AEs cultured normal human nasal epithelial (NHNE) cells.

Methods

Nasal mucosal specimens from three patients are obtained and serially cultured cells are subjected to morphological examinations, RT-PCR, Western blot analysis and immunocytochemistry. AE activity is assessed by pHi measurements.

Results

Expression of ciliated cells on the apical membrane and expression of MUC5AC, a marker of mucous differentiation, increased with time. AE2 and SLC26A4 mRNA expression decreased as mucociliary differentiation progressed, and AE4, SLC26A7 and SLC26A8 mRNA expression increased on the 14th and 28th day after confluence. Accordingly, AE4 protein expression also progressively increased. AE activity in 100 mm K⁺ buffer solutions was nearly twofold higher than that in 5 mm K⁺ buffer solutions. Moreover, only luminal AE activity increased about fourfold over the control in the presence of 5 μm forskolin. In the presence of 100 μm adenosine-5′-triphosphate (ATP) which evokes intracellular calcium signalling through activation of purinergic receptors, only luminal AE activity was again significantly increased. On the other hand, 500 μm 4,4′-diisothiocyanostilbene-2,2′-disulfonic acid (DIDS), an inhibitor of most SLC4 and SLC26AE isoforms, nearly abolished AE activity in both luminal and basolateral membranes. We found that AE activity was affected by intracellular cAMP and calcium signalling in the luminal membrane and was DIDS-sensitive in both membranes of cultured NHNE cells.

Conclusion

Our findings through molecular and functional studies using cultured NHNE cells suggest that AEs may have an important role in the regulation of ASL.