Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach

BACKGROUND

We developed the bilateral, axillo-breast approach (BABA) to endoscopic thyroidectomy and applied it to the da Vinci robotic surgical system in 2008. Herein, we have analyzed the immediate postoperative outcomes and 1-year follow-up results of robotic BABA total thyroidectomy with central node dissection (CND).

METHODS

In 2008 and 2009, 109 patients with PTC underwent robotic BABA total thyroidectomy with CND. Clinicopathologic characteristics, short- and long-term complications, and postoperative thyroglobulin (Tg) level were obtained prospectively and analyzed.

RESULTS

The mean age was 39 ± 10 years and the male to female ratio was 1:5.8. The mean operation time was 206 ± 36 minutes. Transient recurrent laryngeal nerve (RLN) palsy occurred in 17 cases (16%) and transient hypocalcemia in 21 cases (19%). The median follow-up was 12 months. There were 1 and 2 cases of permanent RLN palsy and permanent hypoparathyroidism, respectively. Postoperative radioactive iodine ablation was performed on 54 patients (50%). Their mean stimulated Tg level was 1.84 ± 6.35 ng/mL and 76% had stimulated Tg levels <1.0 ng/mL.

CONCLUSION

Robotic BABA total thyroidectomy with CND yields good postoperative outcomes. Given the excellent cosmetic outcomes, this technique may be a suitable operative alternative for low-risk patients with PTC.

A multicenter, randomized, placebo-controlled, double-blind phase II trial evaluating the optimal dose, efficacy and safety of LC 15-0444 in patients with type 2 diabetes

AIM

The objective of this study was to evaluate the optimal dose, efficacy and safety of a novel dipeptidyl peptidase-4 (DPP-IV) inhibitor, LC15-0444, in Korean subjects with type 2 diabetes mellitus treated by diet and exercise.

METHODS

This study was a double-blind, randomized, multicenter and parallel-group, dose-range finding study. We enrolled 145 patients (91 men and 54 women) with a median age of 53 years and a median body mass index of 25.1 kg/m(2) . The median baseline fasting plasma glucose (FPG) was 8.1 mmol/l, the median HbA1c was 7.9% and the median time since the diagnosis of diabetes was 3 years. After 2 weeks of an exercise/diet programme followed by 2 weeks of a placebo period, the subjects were randomized to one of the four following groups for a 12-week active treatment period: placebo and 50, 100 or 200 mg of LC15-0444.

RESULTS

All three doses of LC15-0444 significantly reduced the HbA1c from baseline compared to the placebo group (-0.06 vs. -0.98, -0.74 and -0.78% in the placebo and 50, 100 and 200 mg groups, respectively), without a significant difference between the doses. Subjects with a higher baseline HbA1c (≥8.5%) had a greater reduction in HbA1c. Insulin secretory function, as assessed using homeostasis model assessment-beta cell, C-peptide and the insulinogenic index, improved significantly with LC15-0444 treatment. Insulin sensitivity, as assessed using homeostasis model assessment-insulin resistance, also improved significantly after 12 weeks of treatment. The 50 and 200 mg groups had significantly reduced total cholesterol and low-density lipoprotein cholesterol levels at 12 weeks compared to the placebo group. No dosage of LC15-0444 affected weight or waist circumference. The incidences of adverse events were similar in all study subjects.

CONCLUSIONS

LC15-0444 monotherapy (50 mg for 12 weeks) improved the HbA1c, FPG level, oral glucose tolerance test results, β-cell function and insulin sensitivity measures, and was well tolerated in Korean subjects with type 2 diabetes.

First measurement of inclusive B→Xsη decays

We report a first measurement of inclusive B→Xsη decays, where Xs is a charmless state with unit strangeness. The measurement is based on a pseudoinclusive reconstruction technique and uses a sample of 657×10(6)BB pairs accumulated with the Belle detector at the KEKB e+e- collider. For MXs < 2.6 GeV/c2, we measure a branching fraction of [26.1±3.0(stat)-2.1+1.9(syst)-7.1+4.0(model)]×10(-5) and a direct CP asymmetry of ACP=-0.13±0.04-0.03+0.02. Over half of the signal occurs in the range MXs > 1.8 GeV/c2.

Raspberry ketone increases both lipolysis and fatty acid oxidation in 3T3-L1 adipocytes

Raspberry ketone (RK) is a natural phenolic compound of the red raspberry. The dietary administration of RK to male mice has been reported to prevent high-fat diet-induced elevation in body weight and to increase lipolysis in white adipocytes. To elucidate a possible mechanism for the antiobesity action of RK, its effects on the expression and the secretion of adiponectin, lipolysis, and fatty acid oxidation in 3T3-L1 were investigated. Treatment with 10 µM of RK increased lipolysis significantly in differentiated 3T3-L1 cells. An immunoassay showed that RK increased both the expression and the secretion of adiponectin, an adipocytokine mainly expressed and secreted by adipose tissue. In addition, treatment with 10 µM of RK increased the fatty acid oxidation and suppressed lipid accumulation in 3T3-L1 adipocytes. These findings suggest that RK holds great promise as an herbal medicine since its biological activities alter the lipid metabolism in 3T3-L1 adipocytes.

Ethyl 4-hy-droxy-2,6-diphenyl-1-[2-(piperidin-1-yl)acet-yl]-1,2,5,6-tetra-hydro-pyridine-3-carboxyl-ate

In the title compound, C₂₇H₃₂N₂O₄, the piperidine and tetra­hydro­pyridine rings adopt chair and half-chair conformations, respectively. The dihedral angle between the two phenyl rings is 32.9 (1)°. The mol­ecular structure is stabilized by a strong intra­molecular O—H⋯O hydrogen bond, generating an S(6) motif. In the crystal, inter­molecular C—H⋯O inter­actions form a ribbon-like structure along the a axis.

Submitral left ventricular aneurysm of ischemic origin: report of two surgical cases

Submitral left ventricular aneurysm has been exclusively recognized in the young African population and its occurrence in other than black Africans is rarely reported. Here we describe two surgical cases of submitral left ventricular aneurysm in Asian elderly persons. Although the aneurysms were typically located beneath the posterior mitral valve leaflet, we could identify diseased coronary arteries as well, unlike the reports in the literature asserting that this type of aneurysm occurs in the absence of coronary disease. The possible racial difference with regard to the etiology is addressed.

1-(2-Bromo-acet-yl)-3-methyl-2,6-diphenyl-piperidin-4-one

In the title compound, C(20)H(20)BrNO(2), the piperidone ring adopts a boat conformation. The phenyl rings are oriented at dihedral angles of 97.8 (2) and 96.0 (1)° with respect to the best plane through the piperidine ring. The dihedral angle between the two phenyl rings is 49.7 (1)°. In the crystal, bifurcated C-H⋯O hydrogen bonds form a R(2) (1)(7) ring motif, linking the mol-ecules into centrosymmetric dimers.

r-2,c-6-Bis(2-methoxy-phen-yl)-t-3,t-5-dimethyl-piperidin-4-one acetic acid solvate

In the title compound, C₂₁H₂₅NO₃·C₂H₄O₂, the piperidone ring adopts a chair conformation. The two meth­oxy groups are nearly coplanar with the aromatic rings to which they are attached. The dihedral angle between the two aromatic rings is 60.9 (2)°. There are two short intra­molecular N—H⋯O contacts. The crystal packing is stabilized by inter­molecular O—H⋯N and C—H⋯O inter­actions.

Genetic analysis of norovirus GII.4 variants circulating in Korea in 2008

Noroviruses are the enteric pathogens most commonly responsible for infectious gastroenteritis and outbreaks of foodborne illness. The GII.4 norovirus, in particular, is responsible for the majority of epidemics. Here, we present data on the distribution of norovirus genotypes in Chungnam, Korea, in 2008, measure genetic variation among GII.4 strains, and compare Korean GII.4 variants with reference strains based on the 237-bp junction of ORF1 and ORF2. We detected 139 different strains, which formed two distinct genetic clusters with significant sequence diversity. One Korean cluster (2008-Korea_a) showed high similarity to the Sakai cluster that appeared in Japan and Europe in 2006. The other cluster (2008-Korea_b) was unique and unrelated to previously reported clusters. Genotype GII.4 was confirmed as the predominant cause of norovirus epidemics in Korea. Foodborne norovirus infections, on the other hand, were generally caused by emerging GII.4 genetic variants similar to those responsible for global epidemics.

Influence of human allogenic bone marrow and cord blood-derived mesenchymal stem cell secreting trophic factors on ATP (adenosine-5'-triphosphate)/ADP (adenosine-5'-diphosphate) ratio and insulin secretory function of isolated human islets from cadaveric donor

Successful islet transplantation (ITx) is not only dependent on the number of islets, but also their quality, including viability, metabolic activity, and function. Islet quality decreases during cultivation after the isolation procedure. To overcome this obstacle, we established the practice of islet and mesenchymal stem cells (MSCs) coculture. This coculture condition improved the ATP (adenosine-5'-triphosphate)/ADP (adenosine-5'-diphosphate) ratio and insulin secretory function in vitro. It is believed that the enhancement of islet quality in islet-MSCs cocultures may be caused by the secretion of active agents by MSCs. Herein we have shown that interleukin-6 (IL-6), vascular endothelial growth factor-A (VEGF-A), hepatocyte growth factor (HGF), and transforming growth factor-beta (TGF-beta) were significantly increased as measured by enzyme-linked immunosorbent assay (ELISA) in MSCs-cultured medium, factors that have been shown to improve the survival, function, and angiogenesis/revascularization of islets. These results indicated that the quality of human islets was enhanced by trophic molecules secreted by MSCs, which influence the intracellular islet ATP content and insulin secretory function.

The state of adverse event reporting and signal generation of dietary supplements in Korea

One of the most important objectives of post-marketing monitoring of dietary supplements is the early detection of unknown and unexpected adverse events (AEs). Since 2006, the Korea Food & Drug Administration (KFDA) has established an AE monitoring system for dietary supplements with emphases on the facilitation of AE reporting from consumers, the creation of a new database for aggregating information from multiple sources, and the proposition of appropriate tools for analyzing the likelihood that a product or an ingredient caused an adverse reaction. During the 3-year period from 2006 through 2008, 1430 AE reports had been collected from consumers and 222 AE reports providing complete case details were extracted by integrating AE reports into the product information. The 'relative AE profile' method was applied first to detect statistically significant signals, resulting in only one substrate-event pair (dietary fiber and vomiting) as a signal. Subsequently, the WHO scale was used to estimate the likelihood that dietary fiber caused vomiting. Due to the limited information available, the KFDA determined that no conclusion could be drawn to support any regulatory action, but that the relationship between dietary fiber and vomiting is an area of concern warranting further investigation.

Measurement of |V{ub}| from inclusive charmless semileptonic B decays

We present the partial branching fraction for inclusive charmless semileptonic B decays and the corresponding value of the Cabibbo-Kobayashi-Maskawa matrix element |V{ub}|, using a multivariate analysis method to access approximately 90% of the B-->X{u}lnu phase space. This approach dramatically reduces the theoretical uncertainties from the b-quark mass and nonperturbative QCD compared to all previous inclusive measurements. The results are based on a sample of 657x10{6} BB[over ] pairs collected with the Belle detector. We find that DeltaB(B-->X{u}lnu;p(l){*B}>1.0 GeV/c)=1.963x(1+/-0.088{stat}+/-0.081{syst})x10{-3}. Corresponding values of |V{ub}| are extracted using several theoretical calculations.

Nerve growth factor and expression of its receptors in patients with diabetic neuropathy

AIMS

Low serum nerve growth factor (NGF) levels have been reported in patients with diabetic peripheral neuropathy (DPN), but the role of NGF in the development of neuropathy is unclear. Thus, we investigated the associations of serum NGF level and NGF receptor activity with the presence and severity of DPN.

METHODS

One hundred and thirty-six patients with Type 2 diabetes were included in this cross-sectional study. Serum NGF levels were measured by ELISA. Expressions of NGF receptors (TrkA and p75(NTR)) were measured by immunohistochemical staining. The presence and severity of DPN were assessed by neuropathy disability score (NDS) and by corneal nerve fibre length (cNFL) and nerve branch density (cNBD) using in vivo confocal microscopy.

RESULTS

Patients with DPN had higher serum NGF levels (56-451 pg/ml) than patients without DPN (4-54 pg/ml). However, in DPN patients, serum NGF was negatively associated with neuropathy severity (mild 222 +/- 64 pg/ml; moderate 114 +/- 17 pg/ml; severe 89 +/- 20 pg/ml). This negative association was consistent in all severity indices (NDS, P < 0.001; cNFL, P < 0.001; cNBD P = 0.010) even after adjustment for age, sex, diabetes duration, insulin use, fasting glucose and glycated haemoglobin. Although NGF receptor activities had significantly (P < 0.05) negative associations with the presence and severity of neuropathy, these associations were not significant when adjusted for other factors.

CONCLUSIONS

Serum NGF level was positively associated with the presence of DPN but negatively associated with neuropathy severity in DPN patients. The change in serum NGF might be a consequence of, rather than a contributor to, the early development of DPN.

Measurement of the differential branching fraction and forward-backward asymmetry for B --> K(*)l+l-

We study B --> K(*)l+l- decays (l = e, mu) based on a data sample of 657 x 10(6) BB pairs collected with the Belle detector at the KEKB e+e- collider. We report the differential branching fraction, isospin asymmetry, K* polarization, and the forward-backward asymmetry (A(FB)) as functions of q2 = M(ll)(2)c2. The fitted A(FB) spectrum exceeds the standard model expectation by 2.7 standard deviations. The measured branching fractions are B(B --> K*l+l-) = (10.7(-1.0)(+1.1) +/- 0.9) x 10(-7) and B(B --> Kl+l-) = (4.8(-0.4)(+0.5) +/- 0.3) x 10(-7), where the first errors are statistical and the second are systematic, with the muon to electron ratios R(K*) = 0.83 +/- 0.17 +/- 0.08 and R(K) = 1.03 +/- 0.19 +/- 0.06.

Development of functional human immune system with the transplantations of human fetal liver/thymus tissues and expanded hematopoietic stem cells in RAG2-/-gamma(c)-/- MICE

BACKGROUND

There is an increasing need for suitable animal models for the study of the human immune system and disease. The purpose of this study was to develop a practical in vivo model of human immune cell repopulation using ex vivo expanded human fetal liver-derived CD34(+) hematopoietic stem cells and subrenally coimplanted fetal liver/thymus tissues.

METHODS

Freshly isolated fetal liver-derived CD34(+) hematopoietic stem cells were frozen until injected and ex vivo expanded with various cytokines for 7 days. After fetal liver/thymus tissues were subrenally coimplanted into preirradiated Rag2(-/-)gamma(c)(-/-) mice, frozen and ex vivo expanded CD34(+) cells were injected intravenously. The peripheral blood of the mice was monitored for the detection of human cell engraftment using flow cytometry. Then we confirmed human T-cell function by in vitro function assays.

RESULTS

After fetal liver/thymus tissues were coimplanted into the irradiated Rag2(-/-)gamma(c)(-/-) mice, with frozen and ex vivo expanded CD34(+) hematopoietic stem cells, human cell engraftments were determined using hCD45 and multilineage markers. The cultured cells with the cytokine combination of stem cell factor, thrombopoietin, Flk2/Flk3 ligand (FL), and interleukin-3 showed stable and long-term engraftment compared to other combinations. The ex vivo expanded human fetal liver-derived CD34(+) hematopoietic stem cells, under our culture conditions, accomplished a large volume of expanded cells that were sustained, demonstrating self-renewal of the evaluated markers, which may have indicated long- term repopulation activity.

CONCLUSION

The results of this study demonstrated a practical mouse model of expanded human immune cells especially T cells in Rag2(-/-)gamma(c)(-/-) mice.

Sjögren’s syndrome myelopathy: spinal cord involvement in Sjögren’s syndrome might be a manifestation of neuromyelitis optica

Objective

To evaluate clinical characteristics, aquaporin (AQP)-4 antibody results, and probability of developing symptoms of neuromyelitis optica (NMO) in patients with Sjögren’s syndrome myelopathy (SSM).

Methods

We identified eight patients with spinal cord involvement from 112 patients with Sjögren’s syndrome (SS) referred to the neurology department. The clinical characteristics and AQP-4 antibody status, based on immunoprecipitation of EGFP-tagged AQP-4, of the patients with SSM were assessed.

Results

All patients with SSM had extensive spinal cord lesions, high mean annual relapse rates, and poor response to steroid treatment. Of the eight patients with SSM, seven patients satisfied the revised diagnostic criteria for NMO or showed positive results from AQP-4 antibody testing; one patient had incomplete follow-up. The clinical manifestations and AQP-4 autoantibody status of patients with SSM did not differ significantly from those of NMO patients without SS.

Conclusion

All patients with SSM had poor prognosis with high mean annual relapse rates, and most seemed to have the clinical and immunological characteristics of NMO. Early aggressive immune therapies should be considered in patients with SSM irrespective of the presence or absence of optic neuritis.

Physiology and pathophysiology of the 5‐HT3receptor

OBJECTIVE

Macrophage inhibitory protein-1alpha (MIP-1alpha), a C-C chemokine, stimulates the activation and migration of leukocytes. We investigated the expression of MIP-1alpha in patients with Behçet's disease (BD) and evaluated the association of the MIP-1alpha levels with disease activity of BD.

METHODS

Serum samples were obtained from 67 BD patients and 30 healthy controls. Simultaneously, whole blood cells were isolated from BD patients (n = 25) and healthy controls (n = 11) and cultured in the absence or presence of lipopolysaccharide (LPS), phytohaemagglutinin (PHA), and phorbol 12-myristate 13-acetate (PMA) plus ionomycin. The concentrations of MIP-1alpha, interleukin-8 (IL-8), regulated on activation, normally T cell expressed and secreted (RANTES), and monocyte chemoattractant protein-1 (MCP-1) were measured in the sera and culture supernatants by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The serum levels of MIP-1alpha were higher in BD patients than in healthy controls. When whole blood cells were stimulated with LPS or PMA plus ionomycin, but not PHA, BD patients had higher levels of MIP-1alpha in the culture supernatants compared to healthy controls. In sera and culture supernatants of whole blood cells, MIP-1alpha levels correlated well with those of RANTES, MCP-1, and IL-8 in BD patients. Moreover, patients with active disease had significantly higher levels of serum MIP-1alpha levels compared with those with inactive disease.

CONCLUSION

MIP-1alpha levels were elevated in patients with BD, and correlated well with IL-8, RANTES, and MCP-1 levels. These results suggest that the increased MIP-1alpha levels in serum of BD patients may lead to activation and migration of leukocytes, playing a role, like other chemokines, in the pathogenesis of BD.

Observation of the doubly cabibbo-suppressed decay D_{s};{+}-->K;{+}K;{+}pi;{-}

We report the first observation of the doubly Cabibbo-suppressed decay D_{s};{+}-->K;{+}K;{+}pi;{-} using 605 fb;{-1} of data collected with the Belle detector at the KEKB asymmetric-energy e;{+}e;{-} collider. The branching ratio with respect to its Cabibbo-favored counterpart B(D_{s};{+}-->K;{+}K;{+}pi;{-})/B(D_{s};{+}-->K;{+}K;{-}pi;{+}) is (0.229+/-0.028+/-0.012)%, where the first uncertainty is statistical and the second is systematic. We also report a significantly improved measurement of the doubly Cabibbo-suppressed decay D;{+}-->K;{+}pi;{+}pi;{-}, with a branching ratio B(D;{+}-->K;{+}pi;{+}pi;{-})/B(D;{+}-->K;{-}pi;{+}pi;{+})=(0.569+/-0.018+/-0.014)%.

Automatic ballistocardiogram (BCG) beat detection using a template matching approach

This paper suggests a beat detection method for ballistocardiogram (BCG) from an unconstrained cardiac signal monitoring devices. A fiducial peak point of BCG is an I-J-K complex which corresponds with ventricle contraction and Electrocardiogram (ECG) QRS complex. The goal of the method is extraction of J peak without ECG synchronization. The detection method is based on a "template matching" rule evaluated using a correlation function in a local moving-window procedure. The total beat detection algorithm operates in two stages, template definition stage and beat detection stage with defined template in previous stage. In the first stage, the BCG template is constructed by the expert with an empirical analysis of BCG signal and measurement device. In the second stage, the correlation function calculates an accuracy of template with BCG signal using a local moving-window. The data analysis has been performed on the subjects tested at Seoul National University Hospital Sleep Medicine Center and presents 95.16% of sensitivity and 94.76% of positive predictivity value for the J peak detection.

The influence of urine volume on body impedance measurement

Bio-signal has some characteristics that the signal is so weak. So, it is good that the factors to influence measured electrical signal are eliminated as much as they can. So, in this paper we will show the influence of urine in bladder on measuring human body impedance. Human urine has different conductivity from other human tissues. Therefore, if the volume of the urine changed, the measured body impedance data also changed.So, in this paper, we will show the influence of urine in bladder with foot-to-foot and thigh-to-thigh current paths. As a result, if the current flows through human bladder, the influence of urine in the bladder must be considered when the body impedance is measured

Amiloride derivatives induce apoptosis by depleting ER Ca(2+) stores in vascular endothelial cells

BACKGROUND AND PURPOSE

Amiloride derivatives are blockers of the Na(+)/H(+) exchanger (NHE) and at micromolar concentrations have protective effects on cardiac and brain ischaemia/reperfusion injury but at higher concentrations also induce apoptosis. Here, we aimed to elucidate the mechanism related to this cytotoxic action.

EXPERIMENTAL APPROACH

We quantified the expression of genes associated with endoplasmic reticulum (ER) stress and measured changes in luminal ER Ca(2+) concentration ([Ca(2+)](ER)) with a 'cameleon' indicator, D1ER.

KEY RESULTS

Amiloride derivatives induced apoptosis in vascular endothelial cells, an effect that increased at alkaline extracellular pH. The potency order for cytotoxicity was 5-(N,N-hexamethylene)-amiloride (HMA) > 5-(N-methyl-N-isobutyl) amiloride > 5-(N-ethyl-N-isopropyl) amiloride (EIPA) >> amiloride. HMA dose-dependently increased the transcription of the ER stress genes GADD153 and GADD34 and rapidly depleted [Ca(2+)](ER), mimicking the effects of the sarco/endoplasmic reticulum ATPase (SERCA) inhibitor thapsigargin. The NHE1-specific inhibitor HOE 694 inhibited NHE activity by 87% but did not alter [Ca(2+)](ER). The decrease in [Ca(2+)](ER) evoked by amiloride derivatives was also observed in HeLa cells and was mirrored by an increase in cytosolic Ca(2+) concentration.

CONCLUSIONS AND IMPLICATIONS

Amiloride derivatives disrupt ER and cytosolic Ca(2+) homeostasis by a mechanism unrelated to NHE inhibition, most likely by interfering with the activity of SERCA. We propose that ER Ca(2+) depletion and subsequent ER stress provide a rationale framework for the apoptotic effects of amiloride derivatives.

Mannose-binding lectin gene-2 polymorphisms and serum mannose-binding lectin levels in Behçet's disease

OBJECTIVE

Behçet's disease (BD) is an autoimmune disease with an unknown etiology and mannose-binding lectin (MBL) is a pattern recognition receptor in the innate immune system, which is associated with some autoimmune diseases. We investigated MBL2 gene polymorphisms and serum MBL levels in BD patients and controls.

METHODS

MBL2 gene polymorphisms in exon 1 (MBL2 54 Gly/Asp, (A/B)), promoter (MBL2 H/L (G-550C), MBL2 Y/X (G-221C)), and 5' UTR region (MBL2 P/Q (C+4T)) were investigated using polymerase chain reaction and restriction fragment length polymorphism in 119 BD patients and 252 healthy controls. Serum MBL levels were measured by enzyme linked immunosorbent assay in 49 BD patients and 102 sex-/genotype-matched controls.

RESULTS

No significant difference was found between BD patients and controls in terms of MBL2 polymorphisms and MBL serum levels. However, the presence of genital ulcer and neurologic involvement were found to be associated with MBL2 54 allele A (OR=2.415, OR=6.632, respectively). Eye involvement was found to be related to the presence of the MBL2 54 AA or AB genotypes (OR=12.46), MBL2-G-550C allele H (OR=1.829). High serum MBL level (> or =500 ng/ml) was associated with skin lesions (p=0.002).

CONCLUSION

The frequencies of the four MBL2 genetic polymorphisms examined were not different in BD patients and healthy controls. However, the presence of genital ulcer, eye involvement, and neuro-Behcet's disease were found to be associated with MBL2 polymorphisms that are associated with the production of high levels of MBL or functional MBL.