Topical niacin cream-assisted 595-nm pulsed-dye laser treatment for facial flushing: retrospective analysis of 25 Korean patients

BACKGROUND

Flushing is defined clinically as a transient reddening of the face and other areas. Due to the transient nature of flushing, a patient may not show signs of flushing during laser treatment.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of 595-nm pulsed-dye laser treatment of flushing or erythema after provocation of flushing by topical niacin cream.

METHODS

We retrospectively reviewed a total of 25 Korean patients with facial flushing who were treated with three sessions of 595-nm pulsed-dye laser after the application of topical niacin cream.

RESULTS

Follow-up results revealed that 12 of the 25 patients demonstrated marked (51-75%) clinical improvement of baseline facial erythema. Eight patients had moderate (26-50%) improvement and three demonstrated near total (≥ 75%) improvement. Two patients showed minimal to no (0-25%) improvement. We observed that the reactivity to topical niacin cream was markedly reduced in 64% of our patients after 595-nm pulsed-dye laser treatments. Minimal post-therapy facial oedema was noted in most of the patients, which usually resolved spontaneously within 2 days. Pronounced facial swelling was observed in four patients.

CONCLUSION

We suggest that 595-nm pulsed-dye laser treatment after provocation of flushing by topical niacin cream may provide a new treatment algorithm for facial flushing in Asians.

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.

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial

BACKGROUND

Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea-associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow.

OBJECTIVES

We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea.

METHODS

Eighteen Korean patients with rosacea were recruited. Three sessions of 585-nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half-faces at 3-week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10-point visual analogue scale.

RESULTS

Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment (P = 0·023 and P = 0·009, respectively). There was no significant difference in the improvement of objective erythema between the two sides. However, based on physician assessment the overall clinical improvement on the niacin side was significantly higher (P = 0·005), and patient satisfaction was also higher on the niacin-pretreated side (P = 0·007). There were no remarkable side-effects, with the exception of transient erythema and oedema.

CONCLUSIONS

Pretreatment with topical niacin safely enhanced the effect of 585-nm PDL treatment of rosacea-associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark-skinned Asians.

Optically based-indentation technique for acute rat brain tissue slices and thin biomaterials

Currently, micro-indentation testing of soft biological materials is limited in its capability to test over long time scales due to accumulated instrumental drift errors. As a result, there is a paucity of measures for mechanical properties such as the equilibrium modulus. In this study, indentation combined with optical coherence tomography (OCT) was used for mechanical testing of thin tissue slices. OCT was used to measure the surface deformation profiles after placing spherical beads onto submerged test samples. Agarose-based hydrogels at low-concentrations (w/v, 0.3-0.6%) and acute rat brain tissue slices were tested using this technique over a 30-min time window. To establish that tissue slices maintained cell viability, allowable testing times were determined by measuring neuronal death or degeneration as a function of incubation time with Fluor-Jade C (FJC) staining. Since large deformations at equilibrium were measured, displacements of surface beads were compared with finite element elastic contact simulations to predict the equilibrium modulus, μ(∞) . Values of μ(∞) for the low-concentration hydrogels ranged from 0.07 to 1.8 kPa, and μ(∞) for acute rat brain tissue slices was 0.13 ± 0.04 kPa for the cortex and 0.09 ± 0.015 kPa for the hippocampus (for Poisson ratio = 0.35). This indentation technique offers a localized, real-time, and high resolution method for long-time scale mechanical testing of very soft materials. This test method may also be adapted for viscoelasticity, for testing of different tissues and biomaterials, and for analyzing changes in internal structures with loading.

Borderline mucinous tumor arising in a paratubal cyst: a case report

BACKGROUND

Paratubal borderline tumors (PBTs) are found incidentally at frozen section or permanant pathology, and are extremely rare. We describe the first case of a paratubal borderline mucinous tumor (PBMT).

CASE REPORT

A 20-year-old woman was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic paratubal cyst enucleation. We used an endobag for cyst extraction. Cyst rupture or tearing of the endobag in the laparoscopic field was absent. Frozen section analysis was reported as a borderline mucinous tumor of low malignant potential. Currently, she has had no evidence of disease recurrence after a laparoscopic fertility-sparing staging procedure.

CONCLUSION

A proper preoperative differential diagnosis of an adnexal mass is difficult. Thus, laparoscopy is needed in large or symptomatic cysts. Although growth, torsion and malignancy are rare in paratubal cysts, the possibility of tumor seeding should be excluded with use of an endobag.

Aggressive angiomyxoma of the vulva treated by using a gonadotropin-releasing hormone agonist: a case report

A rare case of a 38-year-old woman with progesterone receptor-positive aggressive angiomyxoma is presented. She underwent local excision and was treated with a gonadotropin-releasing hormone agonist as adjuvant therapy, and is free of disease 20 months after.

Clinicopathologic analysis of extramammary Paget's disease

PURPOSE

To retrospectively analyze the clinicopathologic characteristics of patients with extramammary Paget's disease who were surgically treated in a single institution.

METHOD

The charts of 14 patients with extramammary Paget's disease were retrospectively reviewed, and the clinicopathologic data were collected and analyzed.

RESULTS

From January 1990 to July 2009, 14 patients were treated at our institution. Most patients (11/14 patients) had delayed diagnosis. Two patients (14.3%) had associated malignant neoplasms. Eight of 14 patients (57.1%) had positive surgical margins; of these patients, five patients had no evidence of recurrence. In the six patients with negative surgical margins, two patients (33.3%) developed recurrence.

CONCLUSIONS

The diagnosis of extramammary Paget's disease is commonly delayed. Because of the possible association with other malignancies before or after the diagnosis of extramammary Paget's disease, thorough examinations are recommended. Disease recurrence is common regardless of the surgical margin status, so long-term monitoring of patients is recommended.

Abstract P3-10-27: Caspase Variant as Prognostic Marker in Patients with Early Breast Cancer

Background: Since apoptosis induced by caspases may play a role in the prognosis of breast cancer, the present study analyzed the polymorphisms of caspase genes and their impact on the survival of 240 patients with early invasive ductal breast cancer.

Material and Methods: The genomic DNA was extracted from paraffin-embedded tumor-free tissue or blood, and 8 single nucleotide polymorphisms (SNPs) of 5 apoptosis-related genes in the apoptosis pathway determined using a Sequenom MassARRAY system. Results: During the median follow-up of 68.6 (range, 36.3-173.1) months, 43 relapses and 25 deaths occurred. Among the target polymorphisms, the caspase 9 gene polymorphism (CASP9 rs4645978) in a dominant model of the A allele was associated with survival in a log-rank test (P &lt; 0.05). In a multivariate analysis, the GA+AA genotype of CASP9 rs4645978 was significantly correlated with a better disease-free survival (HR = 0.250; 95% CI = 0.075 - 0.840; P = 0.025), while marginally with distant disease-free or overall survival (HR = 0.360 and 0.337; P = 0.118 and 0.158, respectively). No clinicopathologic difference was observed according to the genotypes of this polymorphism. Discussion: The CASP9 rs4645978 was identified as a possible prognostic factor of survival in patients with operated invasive breast cancer.

Figures available in online version.

Selective nuclear export mechanism of small RNAs

The timely nuclear-cytoplasmic translocation of proteins and RNAs by importins and exportins is important for controlling biological processes. Since the 2004 publication of the first exportin structure, Cse1p, the X-ray structures of exportin-5 complexed with pre-microRNA, exportin-t complexed with tRNA, and three CRM1-related structures have revealed the binding mechanism involved in specific cargo recognition. Pre-microRNA and tRNA have conserved 3' 2-4-nucleotide overhang motifs and similar short double-stranded regions. Exportin-5 and exportin-t bind a conserved 3' overhang strongly, and they weakly enclose the short double-stranded stems, each in a different manner. The structures of the nuclear export complexes of small double-stranded RNAs, pre-microRNAs, and tRNAs provide information about the specificities of the two exportins in the context of transcription and translation control.

Survival rate of H5N1 highly pathogenic avian influenza viruses at different temperatures

The survival rate of Korean H5N1 highly pathogenic avian influenza (HPAI) viruses was investigated at different temperatures under the laboratory conditions. The estimated survival days for a starting viral concentration of 10(6.5) 50% egg infectious dose/0.1 mL were 930, 1,042, and 3,213 d at 4 degrees C; 226, 232, and 293 d at 20 degrees C; and 51, 55, and 58 d at 30 degrees C for A/chicken/Korea/ES/03, A/chicken/Korea/IS/06, and A/chicken/Korea/Gimje/08 (Gimje/08) viruses, respectively. The stability of the Gimje/08 virus was statistically significant compared with the other 2 viruses except for the data between Gimje/08 and A/chicken/Korea/IS/06 virus at 30 degrees C. This result indicated that the survival rate of 3 Korean HPAI viruses is different at various temperatures, which might have partially influenced the large scale of HPAI outbreak in Korea in 2008.

A novel method for air drying aloe leaf slices by covering with filter papers as a shrink-proof layer

To prevent the shrinkage of aloe vera slices during air drying, a method utilizing a shrink-proof layer was developed. The sample was configured of whole leaf aloe slices, where 1 side or both sides were covered with filter papers as shrink-proof layers. After air drying by varying the air temperature and the slice thickness, the drying characteristics, as well as several quality factors of the dried aloe vera leaf slices, were analyzed. In the simulation of the drying curves, the modified Page model showed the best fitness, representing a diffusion-controlled drying mechanism. Nonetheless, there was a trace of a constant-rate drying period in the samples dried by the method. Shrinkage was greatly reduced, and the rehydration ratios increased by approximately 50%. Scanning electron microscopic analysis revealed that the surface structure of original fibrous form was well sustained. FT-IR characteristics showed that the dried samples could sustain aloe polysaccharide acetylation. Furthermore, the functional properties of the dried slices including water holding capacity, swelling, and fat absorption capability were improved, and polysaccharide retention levels increased by 20% to 30%. Therefore, we concluded that application of shrink-proof layers on aloe slices provides a novel way to overcome the shrinkage problems commonly found in air drying, thereby improving their functional properties with less cost. Practical Application: This research article demonstrates a novel air drying method using shrink-proof layers to prevent the shrinkage of aloe slices. We analyzed extensively the characteristics of shrinkage mechanism and physical properties of aloe flesh gels in this drying system. We concluded that this method can be a beneficial means to retain the functional properties of dried aloe, and a potential alternative to freeze drying, which is still costly.

Health care utilization in patients with gout

OBJECTIVE

To study health care utilization patterns in patients with gout.

METHODS

In a gout population from primary care and rheumatology clinics in 3 U.S. metropolitan cities, we collected data on gout-related utilization (primary care, rheumatology, urgent care, emergency room, and other) in the past year. We evaluated the association of comorbidities, age, gender, gout characteristics (time since last gout attack and tophi), and gout severity ratings (mean of serum uric acid, patient-rated, and physician-rated gout severity) and with emergency/urgent care and primary care utilization using regression and correlation analyses.

RESULTS

Of the 296 patients who reported visiting at least 1 type of health practitioner for gout in the past year, the percentage of patients utilizing the service at least once and annual utilization rates among utilizers were as follows: primary care physician, 60%, 3.0 ± 3.4; nurse practitioner/physician assistant, 26%, 2.7 ± 2.5; rheumatologist, 51%, 3.7 ± 5.7; urgent care, 23%, 2.1 ± 2.2; emergency room, 20%, 2.0 ± 1.7; and hospitalization, 7%, 2.1 ± 1.4. Higher overall gout severity was associated with greater use of each resource type and with overall gout-related utilization. Nonemergency/nonurgent care utilization (primary care physician, nurse practitioner, physician's assistant, and rheumatologist for gout) was the strongest predictor of gout-related emergency/urgent care utilization. Patients with more comorbidities had greater gout-related primary care utilization.

CONCLUSIONS

Overall gout severity was associated with all types of gout-related utilization. This may help to screen high utilizers for targeted behavioral and therapeutic interventions. Having a higher number of comorbid conditions was a risk factor for higher gout-related primary care utilization.

Wear performance of self-mating contact pairs of TiN and TiAlN coatings on orthopedic grade Ti-6Al-4V

Both titanium nitride (TiN) and titanium aluminum nitride (TiAlN) have shown great wear resistance potential in metallic medical devices as protective, hard thin film coatings. In the present study, the effects of TiN and TiAlN coating layers on the wear performance of Ti-6Al-4V were compared and analyzed. TiN and TiAlN coatings with a thickness of 3 microm were deposited by a cathodic vacuum arc ion plating technique on the surface of Ti-6Al-4V. Wear tests were conducted by using a pin-on-disk-type tribotester with a point contact self-mating pair in a linear reciprocal motion. A sliding distance of 20 mm per cycle at 1 Hz was used under a load of 15 N under ambient conditions with no lubricant. The wear resistance of TiN and TiAlN coatings is superior to that of uncoated Ti-6Al-4V at the early stage of sliding contact. Until a measurable amount of wear was detected, the number of sliding cycles of the TiAlN coating pair was longer than TiN. After the first detection of wear from the coating layers, the rate of wear of the TiN coating pairs was significantly higher than that of TiAlN (p < 0.05), and it was close to that of the uncoated pairs. In conclusion, the TiAlN coating is superior to TiN from the viewpoint of wear resistance under the test conditions used in this study.

Optimizing the culture of Plasmodium falciparum in hollow fiber bioreactors

The hollow fiber bioreactor (HFBR) is a cell culturing system allowing continuous perfusion of medium. It was designed to grow microorganisms in a dynamically altering medium mimicking change in the in vivo intravascular and extravascular compartments. The cell compartment (extra capillary space) and medium compartment (intra capillary space) are connected through pores of semipermeable fiber membranes. These membranes allow exchange of gas and nutrients. We have adapted this system for the ex vivo culture of Plasmodiumfalciparum at high parasite densities. A Thai P. falciparum isolate (TM036) cultured in RPMI, supplemented with 0.5% Albumax II, could be maintained continuously in the system by daily changes of a small volumes of medium. Under optimized conditions the HFBR cultures attained 8% parasitemia in 40% hematocrit, thereby providing a total parasite biomass of 6.0 x 10(9) parasitized erythrocytes. The main problem encountered was clogging of micropores in the hollow fiber system by cellular debris over time. Although 'reverse flushing' partly prevented this, a larger pore size might be needed to overcome this problem. The system opens new possibilities for the study of in vitro drug sensitivity under conditions mimicking in vivo pharmacokinetics, and the selection of anti-malarial drug resistance and associated parasite biological and genomic changes.

Chemical approach for specific enrichment and mass analysis of nitrated peptides

The analysis and detection of 3-nitrotyrosine are biologically and clinically important because protein tyrosine nitration is known to be involved in a number of biological phenomena such as cellular signal transduction, pathogenesis of inflammatory responses, and age-related disorders. However, the main obstacles in the study are low abundance of nitrated species and lack of efficient enrichment methods. Here in, we suggest a new chemical approach to analyze nitrated peptides using mass spectrometry by incorporating specific tagging groups in the peptides through simple chemical transformations. Nitro groups on tyrosine side chains of nitrated peptides were subjected to reduction to give rise to amine which was further converted to metal-chelating motif. Mass analyses verified that Ni(2+)-NTA magnetic agarose beads selectively captured and isolated the modified peptides, i.e., nitrated peptides, by strong and specific metal chelating interactions. We further demonstrated the utility of our approach by detection of nitrated peptides in complex samples such as tryptic peptide mixtures of bovine serum albumin (BSA) and a HeLa cell lysate.

The influence of interfacial roughness on the coherence of structure and magnetic coupling across barriers in Fe/MgO multilayers

Single-crystal Fe/MgO multilayers are model systems in which to study magnetic tunnel junctions. We find that the interfacial roughness leads to the loss of coherence of the crystal structure. For thick MgO layers ferromagnetic (FM) ordering is found using polarized neutron reflectivity (PNR). For thin MgO layers magnetization measurements reveal the presence of antiferromagnetic (AF) interactions, but no long-range AF order is found using PNR. After cycling in a hysteresis loop, FM correlations are found at the coercive point, and this will limit the maximum tunnelling magnetoresistance.

Beneficial effect of dietary epigallocatechin-3-gallate on skin via enhancement of antioxidant capacity in both blood and skin

BACKGROUND/AIMS

Dietary antioxidants exert a photoprotective effect against UV radiation. However, the mechanism underlying the beneficial effects on skin of orally administered antioxidant is not very clear. The present study aimed to investigate the UVB-induced total antioxidant capacity (TAC) perturbation both in skin and blood and to study the beneficial mechanism of action of dietary epigallocatechin-3-gallate (EGCG).

METHOD

Female HWY/Slc hairless rats were exposed to UVB radiation for 4 weeks and skin and blood TAC were measured at weeks 0, 2, and 4. The correlation between skin and blood TAC was assessed using Pearson's correlation analysis. To investigate the effect of dietary EGCG, female HWY/Slc hairless rats were fed EGCG and exposed to UVB radiation. At the end of the 8-week experimental period, transepidermal water loss (TEWL) and epidermal thickness were measured to assess skin damage, and TAC was analyzed in both skin and blood.

RESULTS

UVB radiation significantly decreased skin and blood TAC, and there was a significant correlation between skin and blood TAC. Dietary EGCG significantly prevented UVB-induced adverse effects on epidermal thickness and TEWL, and the UVB-induced decrease in TAC recovered in both skin and blood.

CONCLUSION

These results demonstrate that there is a close relationship between skin and blood TAC and the beneficial effect of oral antioxidants on skin may possibly be mediated through significant enhancement of blood TAC.

De novo appearance of primitive neuroectodermal tumor in a patient with systemic lupus erythematosus and moyamoya disease

Primitive neuroectodermal tumor is a rare brain tumor composed of undifferentiated or poorly differentiated neuroepithelial cells with a high malignant potential that usually occurs in children, and which is only occasionally encountered in adults. A 19-year-old female with systemic lupus erythematosus presented with right hemiparesis and a headache of 10 days duration. Brain magnetic resonance imaging showed a large solid mass with necrotic portions in the left frontoparietal lobe. Primitive neuroectodermal tumor was confirmed by a neuronavigator-guided brain biopsy. This is the first case report of primitive neuroectodermal tumor associated with systemic lupus erythematosus and moyamoya disease. This case demonstrates that brain tumors, such as primitive neuroectodermal tumor, should be included in the differential diagnosis of neurological manifestations in children and adolescent patients with systemic lupus erythematosus.

Large conformational changes in the Escherichia coli tryptophan synthase beta(2) subunit upon pyridoxal 5'-phosphate binding

To understand the basis for the lower activity of the tryptophan synthase beta(2) subunit in comparison to the alpha(2)beta(2) complex, we determined the crystal structures of apo-beta(2) and holo-beta(2) from Escherichia coli at 3.0 and 2.9 A resolutions, respectively. To our knowledge, this is the first report of both beta(2) subunit structures with and without pyridoxal-5'-phosphate. The apo-type molecule retained a dimeric form in solution, as in the case of the holo-beta(2) subunit. The subunit structures of both the apo-beta(2) and the holo-beta(2) forms consisted of two domains, namely the N domain and the C domain. Although there were significant structural differences between the apo- and holo-structures, they could be easily superimposed with a 22 degrees rigid body rotation of the C domain. The pyridoxal-5'-phosphate-bound holo-form had multiple interactions between the two domains and a long loop (residues 260-310), which were missing in the apo-form. Comparison of the structures of holo-Ecbeta(2) and Stbeta(2) in the alpha(2)beta(2) complex from Salmonella typhimurium (Stalpha(2)beta(2)) identified the cause of the lower enzymatic activity of holo-Ecbeta(2) in comparison with Stalpha(2)beta(2). The substrate (indole) gate residues, Tyr279 and Phe280, block entry of the substrate into the beta(2) subunit, although the indole can directly access the active site as a result of a wider cleft between the N and C domains in the holo-Ecbeta(2) subunit. In addition, the structure around betaAsp305 of the holo-Ecbeta(2) subunit was similar to the open state of Stalpha(2)beta(2) with low activity, resulting in lower activity of holo-Ecbeta(2).

In-vitro study on haemodiluted blood flow in a sinusoidal microstenosis

In-vitro experiments were carried out to investigate the haemodynamic and haemorheological behaviours of haemodiluted blood flow through a microstenosis using a micro-particle image velocimetry (PIV) technique. The micro-PIV system employed in this study consisted of a two-head neodymium:yttrium-aluminium-garnet (Nd:YAG) laser, a cooled charge-coupled device camera, and a delay generator. To simulate blood flow in a stenosed vascular vessel, a polydimethylsiloxane (PDMS) microchannel with a sinusoidal throat of 80 per cent severity was employed. The width and depth of the microchannel were 100 microm and 50 microm, respectively. To compare the flow characteristics in the microstenosis, the same experiments were repeated in a straight microchannel under the same flow conditions. Using a syringe pump, human blood with 5 per cent haematocrit was supplied into the microstenosis channel. The flow characteristics and transport of blood cells through the microstenosis were investigated with various flowrates. The mean velocity fields were nearly symmetric with respect to the channel centreline. In the contraction section, the oncoming blood flow was accelerated rapidly, and the maximum velocity at the throat was almost 4.99 times faster than that of the straight microchannel without stenosis. In the diffusion section, the blood cells show rolling, deformation, twisting, and tumbling motion due to the flow-choking characteristics at the stenotic region. The results from this study will provide useful basic data for comparison with those obtained by clinical researchers.

Efficacy and safety of 1064-nm Q-switched Nd:YAG laser with low fluence for keloids and hypertrophic scars

BACKGROUND

Several treatment modalities using laser devices have been used for the treatment of keloids and hypertrophic scars with various therapeutic outcomes.

OBJECTIVE

The purpose of this study was to describe the efficacy and safety of 1064-nm Q-switched (QS) Nd:YAG laser with low fluence on keloids and hypertrophic scars.

METHODS

Keloids and hypertrophic scars located at 21 anatomic sites in 12 Korean patients (10 men and 2 women; mean age 23.8 years, range 21-33) were treated using 1064-nm QS Nd:YAG laser with low fluence at 1-2 week intervals. Treatment settings were 1.8-2.2 J/cm(2), 7-mm spot size and 5-6 passes with appropriate overlapping.

RESULTS

Follow-up data collected 3 months after the final treatment revealed decreases in the mean score for the following lesion characteristics: pigmentation from 1.8 to 1.2; vascularity from 1.4 to 1.0; pliability from 3.0 to 2.0 and height from 2.3 to 1.8. The modified Vancouver General Hospital Burn Scar Assessment score decreased from 8.6 to 5.9 (P < 0.0001). Observed side-effects were a mild prickling sensation during treatment, and mild post-treatment erythema, both of which resolved within few hours.

CONCLUSION

Our results demonstrate that QS Nd:YAG laser with low fluence may be used for the treatment of keloids and hypertrophic scars.

The Cut-Off Rate of Skin Temperature Change to Confirm Successful Lumbar Sympathetic Block

The purpose of this study was to find the best cut-off value for the rate of change in temperature of the plantar surface of the foot for predicting the success of lumbar sympathetic block (LSB). A total of 185 LSBs were performed on 82 patients via a posterolateral approach under fluoroscopic guidance. Successful LSB was considered to have occurred when changes in the ipsilateral temperature between preblock and post-block were ≥ 2 °C. A receiver operating characteristic (ROC) curve for the minimum rate of temperature change was constructed as a predictor of the onset of a successful LSB. The area under the ROC curve was 0.971 at the rate of 0.4°C/min with a sensitivity of 89.5% and a specificity of 91.8%. Achieving a rate of temperature change of 0.4°C/min within approximately 5 min of the injection of local anaesthetic could be used as an indicator of the onset of successful LSB.

A high-resolution structure of the pre-microRNA nuclear export machinery

Nuclear export of microRNAs (miRNAs) by exportin-5 (Exp-5) is an essential step in miRNA biogenesis. Here, we present the 2.9 angstrom structure of the pre-miRNA nuclear export machinery formed by pre-miRNA complexed with Exp-5 and a guanine triphosphate (GTP)-bound form of the small nuclear guanine triphosphatase (GTPase) Ran (RanGTP). The x-ray structure shows that Exp-5:RanGTP recognizes the 2-nucleotide 3' overhang structure and the double-stranded stem of the pre-miRNA. Exp-5:RanGTP shields the pre-miRNA stem from degradation in a baseball mitt-like structure where it is held by broadly distributed weak interactions, whereas a tunnel-like structure of Exp-5 interacts strongly with the 2-nucleotide 3' overhang through hydrogen bonds and ionic interactions. RNA recognition by Exp-5:RanGTP does not depend on RNA sequence, implying that Exp-5:RanGTP can recognize a variety of pre-miRNAs.

Comparison of cortical bone thickness and root proximity at maxillary and mandibular interradicular sites for orthodontic mini-implant placement

OBJECTIVES

To compare maxillary and mandibular cortical bone thickness and rootic proximity for optimal mini-implant placement.

SETTING AND SAMPLE POPULATION

CT images from 14 men and 14 women were used to evaluate buccal interradicular cortical bone thickness and root proximity from mesial of the central incisor to the 2nd molar. Cortical bone thickness was measured at 0 degrees , 15 degrees , 30 degrees , and 45 degrees angles relative to the root surface using three-dimensional images.

RESULTS

For the cortical bone thickness, there was no statistically significant difference between the maxilla and the mandible in the anterior area; however, there was a significant difference in the posterior area. Cortical bone in the maxilla, mesial and distal to canine interradicular sites, was thickest while thickness in the mandible exhibited a gradual anterior to posterior increase. Cortical bone thickness in the maxilla increased as both level and angle increased, while the cortical bone thickness in the mandible was greatest at 4 mm from the alveolar crest. Root proximity mesial and distal to 2nd premolar interradicular sites was greatest.

CONCLUSION

Based on our results, cortical bone thickness depends on the interradicular site rather than sex or individual differences.

Synergy of TLR2 and H1R on Cox-2 Activation in Pulpal Cells

Although pulp fibroblasts are a major cell type in dental pulp, their roles in microbial recognition and pulpal inflammation are not well-understood. Considering the pivotal role of Toll-like receptors (TLRs) in the recognition of micro-organisms, we hypothesized that TLRs on pulp fibroblasts may induce inflammatory signals in dental pulp. In human pulp fibroblasts, TLR2, 3, 4, and 5 were constitutively expressed. Stimulation of TLR2 and 3 induced the expression of pro-inflammatory genes such as CXCL10, CCL5, and/or Cox-2 in pulp fibroblasts. Interestingly, histamine synergistically activated TLR2-mediated Cox-2 expression and PGE(2) production. The synergistic effect of histamine is mediated by histamine receptor-1 (H1R). Studies on the intra-cellular signaling pathways revealed that p38 activation is required for the synergistic activation of Cox-2 by TLR2 and histamine. Analysis of these data suggests that TLR2 on pulp fibroblasts, in concert with H1R, can induce an inflammatory response during microbial infection in dental pulp.

Role of purinergic receptor in alpha fodrin degradation in Par C5 cells

Autoantibodies specific for alpha-fodrin fragments are found in the tissues of persons afflicted with Sjögren's syndrome (SS). However, the mechanism for alpha-fodrin degradation remains elusive. The following experiments utilized Par C5 cells to examine the role of P2X7 receptor (P2X7R) in apoptosis, particularly in the cleavage and release of alpha-fodrin, an apparent SS autoantigen. Five mM ATP stimulation induced apoptotic cell death with a sustained Ca2+ influx, which was mimicked in HEK cells transfected with P2X7R. ATP also induced cleavage of alpha-fodrin mediated by caspase-3 and calpain, releasing alpha-fodrin fragments through membrane blebs. However, both apoptotic cell death and alpha-fodrin cleavage were inhibited in the presence of 300 microM oxidized-ATP (ox-ATP), an irreversible blocker of P2X7R, or in Ca(2+)-free solution. We concluded that P2X7R plays an important role in apoptosis and alpha-fodrin degradation in salivary epithelial cells, providing an important clue elucidating the presence of alpha-fodrin fragments in SS tissues.

Celecoxib induces hepatic stellate cell apoptosis through inhibition of Akt activation and suppresses hepatic fibrosis in rats

BACKGROUND AND AIMS

Activated hepatic stellate cells (HSCs) but not quiescent HSCs express cyclo-oxygenase-2 (COX-2), suggesting that the COX-2/prostanoid pathway has an active role in hepatic fibrogenesis. However, the role of COX-2 inhibitors in hepatic fibrogenesis remains controversial. The aim of this study was to investigate the antifibrotic effects of celecoxib, a selective COX-2 inhibitor.

METHODS

The effects of various COX inhibitors-that is, ibuprofen, celecoxib, NS-398 and DFU, were investigated in activated human HSCs. Then, the antifibrotic effect of celecoxib was evaluated in hepatic fibrosis developed by bile duct ligation (BDL) or peritoneal thioacetamide (TAA) injection in rats.

RESULTS

Celecoxib, NS-398 and DFU inhibited platelet-derived growth facor (PDGF)-induced HSC proliferation; however, only celecoxib (> or =50 microM) induced HSC apoptosis. All COX inhibitors completely inhibited prostaglandin E(2) (PGE(2)) and PGI(2) production in HSCs. Separately, PGE(2) and PGI(2) induced cell proliferation and extracellular signal-regulated kinase (ERK) activation in HSCs. All COX inhibitors attenuated ERK activation, but only celecoxib significantly inhibited Akt activation in HSCs. Celecoxib-induced apoptosis was significantly attenuated in HSCs infected with adenovirus containing a constitutive active form of Akt (Ad5myrAkt). Celecoxib had no significant effect on PPARgamma (peroxisome proliferator-activated receptor gamma) expression in HSCs. Celecoxib inhibited type I collagen mRNA and protein production in HSCs. Oral administration of celecoxib (20 mg/kg/day) significantly decreased hepatic collagen deposition and alpha-SMA (alpha-smooth muscle actin) expression in BDL- and TAA-treated rats. Celecoxib treatment significantly decreased mRNA expression of COX-2, alpha-SMA, transforming growth factor beta1 (TGFbeta1) and collagen alpha1(I) in both models.

CONCLUSIONS

Celecoxib shows a proapoptotic effect on HSCs through Akt inactivation and shows antifibrogenic effects in BDL- and TAA-treated rats, suggesting celecoxib as a novel antifibrotic agent of hepatic fibrosis.

Obstetric ultrasound scanning by local health workers in a refugee camp on the Thai-Burmese border

OBJECTIVES

Ultrasound examination of the fetus is a powerful tool for assessing gestational age and detecting obstetric problems but is rarely available in developing countries. The aim of this study was to assess the intraobserver and interobserver agreement of fetal biometry by locally trained health workers in a refugee camp on the Thai-Burmese border.

METHODS

One expatriate doctor and four local health workers participated in the study, which included examinations performed on every fifth pregnant woman with a singleton pregnancy between 16 and 40 weeks' gestation, and who had undergone an early dating ultrasound scan, attending the antenatal clinic in Maela refugee camp. At each examination, two examiners independently measured biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL), with one of the examiners obtaining duplicate measurements of each parameter. Intraobserver measurement error was assessed using the intraclass correlation coefficient (ICC) and interobserver error was assessed by the Bland and Altman 95% limits of agreement method.

RESULTS

A total of 4188 ultrasound measurements (12 per woman) were obtained in 349 pregnancies at a median gestational age of 27 (range, 16-40) weeks in 2008. The ICC for BPD, HC, AC and FL was greater than 0.99 for all four trainees and the doctor (range, 0.996-0.998). For gestational ages between 18 and 24 weeks, interobserver 95% limits of agreement corresponding to differences in estimated gestational age of less than +/- 1 week were calculated for BPD, HC, AC and FL. Measurements by local health workers showed high levels of agreement with those of the expatriate doctor.

CONCLUSIONS

Locally trained health workers working in a well organized unit with ongoing quality control can obtain accurate fetal biometry measurements for gestational age estimation. This experience suggests that training of local health workers in developing countries is possible and could allow effective use of obstetric ultrasound imaging.

Role of protein tyrosine nitration in neurodegenerative diseases and atherosclerosis

Nitric oxide generates reactive nitrosative species, such as peroxynitrite (ONOO(-)) that may be involved in a number of diseases. ONOO(-) can mediate protein tyrosine nitration which causes structural changes of affected proteins and leads to their inactivation. Various proteomics and immunological methods including mass spectrometry combined with both liquid and 2-D PAGE, and immunodetection have been employed to identify and characterize nitrated proteins from pathological samples. This review presents the pahtobiological roles of the pathogenic posttranslational modification in neurodegenerative diseases and atherosclerosis.

An outbreak of highly pathogenic avian influenza at a public animal exhibit in seoul, Korea, during 2008

This study describes the first recorded outbreak of HPAI in the city of Seoul, in captive birds held in an exhibition for public viewing at a local district office. The index cases were two pheasants, which had been introduced into the exhibit on 24 April, 4 days prior to death, from a store in a local market in Gyeonggi-do. Ducks and chickens from an HPAI outbreak farm, subsequently confirmed on 4 May, had also been held in this store. This outbreak highlights the potential role of local markets in AIV transmission. This outbreak led to considerable public health concern in Korea, however, no human cases were reported. The non-commercial poultry sector needs to be considered in national plans for preparedness and response.

A simple, effective and cheap device for the safe irrigation of open traumatic wounds

This study reports the use of an overturned plastic gallipot from a sterile wound dressing pack as a splashguard during the irrigation of traumatic wounds with a device consisting of a 20 ml syringe and a 21F gauge hypodermic needle. This simple, effective and cheap device can be constructed from items readily available within the emergency department or operating theatre and minimises exposure to biologically hazardous material during wound irrigation.

Antitumor activity of cytokine-induced killer cells in nude mouse xenograft model

Malignant glioma is the most common primary brain tumor in adults and the median survival for patients is less than a year. Despite aggressive treatments including surgical resection, radiotherapy, and chemotherapy, only modest improvement has been achieved in the survival of patients with glioma. In this study, the antitumor activity of cytokine-induced killer (CIK) cells against human glioma cancer was evaluated in vitro and in vivo. Human peripheral blood mononuclear cells were cultured with IL-2-containing medium in anti-CD3 antibody-coated flasks for 5 days, followed by incubation in IL-2-containing medium for 9 days. The number of cells increased more than 200-fold and the viability was >90%. The resulting populations were consisted of 96% CD3(+), 2% CD3(-)CD56(+), 68% CD3(+)CD56(+), 2% CD4(+), <1% CD4(+)CD56(+), 80% CD8(+), and 49% CD8(+)CD56(+). This heterogeneous cell population was called as CIK cells. At an effector-target cell ratio of 30:1, CIK cells destroyed 43% of U-87 MG human glioma cells, as measured by the (51)Cr-release assay. In addition, CIK cells at doses of 0.3, 1, and 3 million cells per mouse inhibited 23%, 40%, and 50% of U-87 MG tumor growth in nude mouse xenograft assays, respectively. This study suggests that CIK cells may be used as an adoptive immunotherapy for glioma cancer patients.

Acne-photodynamic therapy with intra-lesional injection of 5-aminolevulinic acid

Photodynamic therapy (PDT) is a treatment option for acne patients who fail to respond to conventional therapy. Although potent, we experience side effects such as erythema, exfoliation and dyspigmentation. In attempt to specify treatment and shorten the incubation time, we injected 5-aminolevulinic acid (ALA) to the individual lesion. The results of intralesional injection ILI-PDT and conventional PDT are compared in this study.

Lupus-associated pancreatitis complicated by pancreatic pseudocyst and central nervous system vasculitis

Pancreatitis is an uncommon manifestation of systemic lupus erythematosus (SLE), but this can occasionally cause major complications. We report in this article, a case of 33-year-old female patient who developed lupus-associated pancreatitis that was subsequently complicated by pancreatic pseudocyst and central nervous system (CNS) vasculitis. Abdominal computed tomography (CT) showed an oedematous swelling of the pancreas and a pseudocyst measuring 4 x 3 cm2. Brain magnetic resonance imaging (MRI) showed multiple high-signal intensity lesions in both cerebral hemispheres. The pseudocyst did not completely resolve with high-dose steroid therapy, and it was later complicated by infection and rupture. After a surgical drainage for the complicated pseudocyst, her clinical symptoms and signs were markedly improved. This case shows the importance of performing early drainage rather than conservative treatment for a pancreatic pseudocyst in a patient with lupus-associated pancreatitis.

Cordycepin inhibits IL-1beta-induced MMP-1 and MMP-3 expression in rheumatoid arthritis synovial fibroblasts

OBJECTIVE

MMP is a key enzyme in the degradation of extracellular matrices, and its expression plays important roles in inflammatory diseases. Cordycepin (3'-deoxyadenosine), a bioactive compound of Cordyceps militaris, has been shown to exhibit many pharmacological activities, such as anti-cancer, anti-inflammatory and anti-infection activities. In this study, we aimed at the inhibitory effect of cordycepin on IL-1beta-induced MMP-1 and MMP-3 expression as well as the molecular basis using RA synovial fibroblasts (RASFs).

METHODS

RASFs were isolated from synovial tissue obtained from 12 patients with RA and cultured in monolayer. Expression of MMP-1 and MMP-3 was evaluated using western blotting and real-time PCR. Chemokines were analysed by ELISA. The phosphorylation of mitogen-activated protein kinase was measured by western blotting. Electrophoretic mobility shift assay was performed to evaluate binding activities of DNA to nuclear factor-kappaB (NF-kappaB) and activator protein-1 (AP-1).

RESULTS

Cordycepin inhibited IL-1beta-induced MMP-1 and MMP-3 expressions in RASFs in a dose-dependent manner. Among various chemokines [such as monocyte chemoattractant protein-1 (MCP-1), GRO-alpha, regulated upon activation, normal T-cell expressed and presumably secreted (RANTES) and epithelial neutrophil activating peptide 78 (ENA-78)], cordycepin specifically blocked IL-1beta-induced ENA-78 production in RASF. Moreover, cordycepin significantly inhibited IL-1beta-induced p38/JNK and AP-1 activation, but not extracellular signal-regulated kinase (ERK) and NF-kappaB activation.

CONCLUSIONS

Cordycepin is a potent inhibitor of IL-1beta-induced chemokine production and MMP expression and strongly blocks the p38/JNK/AP-1 signalling pathway in RASFs.

Effects of oral epigallocatechin gallate supplementation on the minimal erythema dose and UV-induced skin damage

BACKGROUND/AIMS

Excessive exposure to UV radiation causes acute adverse effects like sunburn and photosensitivity reactions and is involved in the induction and development of skin cancer. It has been reported that antioxidants have photoprotective effects against solar UV radiation. We investigated the effect of oral epigallocatechin gallate (EGCG), a powerful antioxidant in green tea, on the minimal erythema dose (MED) and UV-induced skin damage.

METHOD

Female HWY/Slc hairless rats were fed the normal diet supplemented with 1,500 ppm EGCG for 8 weeks; then, the MED was determined and visual scores and transepidermal water loss were assessed to evaluate the severity of UV-induced skin damage.

RESULTS

At week 8 of the study, the use of dietary EGCG significantly increased MED. UV-radiation-induced sunburn severity and alterations in epidermal barrier function were also attenuated by the supplementation of EGCG.

CONCLUSION

Regular intake of EGCG strengthens the skin's tolerance by increasing MED and thus prevents UV-induced perturbation of epidermal barrier function and skin damage. These results suggest that EGCG is a potent candidate for systemic photoprotection.

Microwave absorption measurements using a broad-band meanderline approach

We describe a technique that permits broad-band, field-dependent ferromagnetic and electron paramagnetic resonance absorption measurements that is applicable to thin films and patterned micro-/nanostructured arrays and is based on a wire-wound meanderline approach. Techniques to prepare meanderlines and perform microwave measurements are described along with some demonstrations involving an electron paramagnetic resonance calibration/test material, 2,2-diphenyl-1-picryl-hydrazyl, and a ferromagnetic cobalt thin film.

Low seroprevalence of HIV and syphilis in pregnant women in refugee camps on the Thai-Burma border

SUMMARY

Refugee and migrant populations are considered to be at high risk from sexually transmitted infection (STI) and HIV. Cross-sectional surveys for syphilis and HIV were conducted in antenatal clinics (ANCs) on the Thai-Burmese border. In Mae La refugee camp, the seroprevalence of HIV and syphilis were 0.2% (one of 500) (95% CI 0-1.1) and 0% (0 of 404) (95% CI 0-0.9) in 1997; and 0.4% (two of 500) (95% CI 0.1-1.4) and 0.4% (three of 741) (95% CI 0.1-1.2) in 2005, respectively; syphilis seroprevalence in migrant women in 2005 was 0 (0 of 234) (95% CI 0-1.6). The seroprevalence was lower than that reported from surrounding ANCs for Thai or Burmese women. Focus group discussions with HIV-negative and -positive pregnant refugee women established that aspects of Karen culture and isolation (geographical and political) had a significant protective role from HIV and STI. This survey has resulted in programmatic changes in services to pregnant women in this area.

The gep oncogenes, Galpha(12) and Galpha(13), upregulate the transforming growth factor-beta1 gene

Transforming growth factor-beta1 (TGFbeta1) plays a role in neoplastic transformation and transdifferentiation. Galpha(12) and Galpha(13), referred to as the gep oncogenes, stimulate mitogenic pathways. Nonetheless, no information is available regarding their roles in the regulation of the TGFbeta1 gene and the molecules linking them to gene transcription. Knockdown or knockout experiments using murine embryonic fibroblasts and hepatic stellate cells indicated that a Galpha(12) and Galpha(13) deficiency reduced constitutive, auto-stimulatory or thrombin-inducible TGFbeta1 gene expression. In contrast, transfection of activated mutants of Galpha(12) and Galpha(13) enabled the knockout cells to promote TGFbeta1 induction. A promoter deletion analysis suggested that activating protein 1 (AP-1) plays a role in TGFbeta1 gene transactivation, which was corroborated by the observation that a deficiency of the G-proteins decreased the AP-1 activity, whereas their activation enhanced it. Moreover, mutation of the AP-1-binding site abrogated the ability of Galpha(12) and Galpha(13) to induce the TGFbeta1 gene. Transfection of a dominant-negative mutant of Rho or Rac, but not Cdc42, prevented gene transactivation and decreased AP-1 activity downstream of Galpha(12) and Galpha(13). In summary, Galpha(12) and Galpha(13) regulate the expression of the TGFbeta1 gene through an increase in Rho/Rac-dependent AP-1 activity, implying that the G-protein-coupled receptor (GPCR)-Galpha(12) pathway is involved in the TGFbeta1-mediated transdifferentiation process.

The effect of pneumoperitoneum and Trendelenburg position on acute cerebral blood flow-carbon dioxide reactivity under sevoflurane anaesthesia

This study compared cerebral blood flow-carbon dioxide (CBF-CO2) reactivities in the supine and modest Trendelenburg position under pnemoperitoneum during sevoflurane anaesthesia. After induction of anaesthesia in 25 patients, mechanical ventilation was adjusted to increase Paco2 from 4.7 (T1) to 6.0 kPa (T2) in the supine position, and the change in jugular bulb oxygen saturation was measured as an index of CBF. Then, after establishment of pneumoperitoneum and 30 degrees Trendelenburg position, the CO(2) step and measurement of CBF were repeated. The CBF-CO2 reactivity was 7.5 (3.3) %xkPa(-1) (% change in jugular bulb oxygen saturation per unit change in Paco2) in the supine position and 6.8 (2.3) %xkPa(-1) in the 30 degrees Trendelenburg-pneumoperitoneum condition (p = 0.086). We conclude that CBF-CO2 reactivity is unchanged by the modest Trendelenburg position under pneumoperitoneum during sevoflurane anaesthesia.