Clinical effect of torsemide in a horse with congestive heart failure and atrial fibrillation

In this case report, a high dose of torsemide (6mg/kg, every 12 hours for 3 days followed by 12mg/kg, every 12 hours for 4 days) was administered orally to a horse with congestive heart failure (CHF) and atrial fibrillation. Blood samples for measurement of plasma torsemide concentrations were obtained one hour after each drug administration. Pharmacodynamic effects of oral torsemide were evaluated by daily physical examination, electrocardiography, and serum biochemistry. The horse tolerated administration of torsemide. A decrease in ventral oedema and venous congestion was subjectively noted at day 7. Torsemide plasma concentration markedly increased at day 5 (peak concentration of 15.41 µg/mL). Evidence of an increase in renal markers was observed throughout the study period. Electrolyte measurements revealed mild hyponatremia and hypochloremia, and moderate hypokalaemia. No electrocardiographic changes related to torsemide administration were observed. After seven days of treatment, the horse was euthanised due to his disease stage and poor prognosis. Results indicate that torsemide was absorbed after oral administration and was well tolerated in this horse. Furthermore, clinical improvement in this single case indicates that torsemide might be utilized as an oral alternative to furosemide in the management of equine patients in CHF. The high doses of torsemide used in this case report should be reserved for cases without clinical response to lower doses and with close monitoring of electrolytes and renal function parameters. Further investigation of torsemide clinical efficacy and safety in horses with CHF with a larger cohort and prolonged administration is warranted.

Observation of topological superconductivity in a stoichiometric transition metal dichalcogenide 2M-WS2

Topological superconductors (TSCs) are unconventional superconductors with bulk superconducting gap and in-gap Majorana states on the boundary that may be used as topological qubits for quantum computation. Despite their importance in both fundamental research and applications, natural TSCs are very rare. Here, combining state of the art synchrotron and laser-based angle-resolved photoemission spectroscopy, we investigated a stoichiometric transition metal dichalcogenide (TMD), 2M-WS₂ with a superconducting transition temperature of 8.8 K (the highest among all TMDs in the natural form up to date) and observed distinctive topological surface states (TSSs). Furthermore, in the superconducting state, we found that the TSSs acquired a nodeless superconducting gap with similar magnitude as that of the bulk states. These discoveries not only evidence 2M-WS₂ as an intrinsic TSC without the need of sensitive composition tuning or sophisticated heterostructures fabrication, but also provide an ideal platform for device applications thanks to its van der Waals layered structure.

Early data on long-term efficacy and safety of inotersen in patients with hereditary transthyretin amyloidosis: a 2-year update from the open-label extension of the NEURO-TTR trial

BACKGROUND AND PURPOSE

Hereditary transthyretin (hATTR) amyloidosis causes progressive polyneuropathy resulting from transthyretin (TTR) amyloid deposition throughout the body, including the peripheral nerves. The efficacy and safety of inotersen, an antisense oligonucleotide inhibitor of TTR protein production, were demonstrated in the pivotal NEURO-TTR study in patients with hATTR polyneuropathy. Here, the long-term efficacy and safety of inotersen are assessed in an ongoing open-label extension (OLE) study.

METHODS

Patients who completed NEURO-TTR were eligible to enroll in the OLE (NCT02175004). Efficacy assessments included the modified Neuropathy Impairment Score plus seven neurophysiological tests composite score (mNIS + 7), the Norfolk Quality of Life - Diabetic Neuropathy (Norfolk QOL-DN) questionnaire total score and the Short-Form 36 Health Survey (SF-36) Physical Component Summary (PCS) score. Safety and tolerability were also assessed.

RESULTS

Overall, 97% (135/139) of patients who completed NEURO-TTR enrolled in the OLE. Patients who received inotersen for 39 cumulative months in NEURO-TTR and the OLE continued to show benefit; patients who switched from placebo to inotersen in the OLE demonstrated improvement or stabilization of neurological disease progression by mNIS + 7, Norfolk QOL-DN and SF-36 PCS. No new safety concerns were identified. There was no evidence of increased risk for grade 4 thrombocytopenia or severe renal events with increased duration of inotersen exposure.

CONCLUSION

Inotersen slowed disease progression and reduced deterioration of quality of life in patients with hATTR polyneuropathy. Early treatment with inotersen resulted in greater long-term disease stabilization than delayed initiation. Routine platelet and renal safety monitoring were effective; no new safety signals were observed.

Effects of dietary energy levels on physiological parameters and reproductive performance of gestating sows over three consecutive parities

OBJECTIVE

This experiment was to evaluate the effects of the dietary energy levels on the physiological parameters and reproductive performance during gestation over three parities in sows.

METHODS

A total of 52 F1 gilts (Yorkshire×Landrace) were allotted to one of four dietary treatments using a completely randomized design. The treatments contained 3,100, 3,200, 3,300, or 3,400 kcal of metabolizable energy (ME)/kg diet but feed was provided at 2.0, 2.2, and 2.4 kg/d in the first, second and third parity, respectively.

RESULTS

The body weight and body weight gain during gestation increased as the dietary energy level increased (p<0.05, and p<0.01) in the first parity. In the second parity, the body weight of sows was the lowest (p<0.05) when 3,100 kcal of ME/kg treatment diet was provided. The body weight was higher as the dietary energy level increased (p<0.05) during the gestation period in the third parity. During lactation, the voluntary feed intake of lactating sows tended to decrease when gilts were fed higher energy treatment diet (p = 0.08) and the body weight, body weight gain were increased by dietary energy level during gestation (p< 0.05). Backfat thickness was not affected by dietary treatment during the gestation period in three parities, interestingly backfat change from breeding to d 110 of gestation was higher as the dietary energy level increased at the first parity (p<0.05). When gilts were fed 3,400 kcal of ME/kg treatment diet a higher number of weaning piglets was observed in the first parity (p<0.05). The highest culling rate (69%) was seen when gestating sows were fed 3,100 kcal/kg ME treatment diet during three parities.

CONCLUSION

In conclusion, the adequate energy intake of gestating sows should be 6,400 or 6,600 kcal of ME/d, 7,040 or 7,260 kcal of ME/d, and 7,680 or 7,920 kcal of ME/d for parity 1, 2, and 3, respectively.

Effect of rapeseed meal supplementation to gestation diet on reproductive performance, blood profiles and milk composition of sows

Objective

This experiment evaluated the effect of dietary supplementation levels of rapeseed meal (RSM) in gestation diets on reproductive performance, blood profiles, milk composition of sows, and growth of their progeny.

Methods

A total of 55 mixed-parity sows (Yorkshire×Landrace; average parity = 3.82) with an initial body weight (BW) of 193.0 kg were used in this experiment. Sows were allotted to one of 5 treatments at breeding based on BW and backfat thickness in a completely randomized design. Treatments consisted of dietary RSM supplementation levels (0%, 3%, 6%, 9%, and 12%) in gestation diets. During lactation all sows were fed a common lactation diet with no RSM supplementation.

Results

Body weight, backfat thickness, litter size, lactation feed intake, and milk composition of sows, and growth of their progeny were not different among dietary treatments. In blood profiles, a quadratic increase (Quadratic, p<0.05) in serum triiodothyronine (T3) concentration and a linear increase (Linear, p<0.01) in serum thyroxine (T4) concentration were observed at d 110 of gestation as dietary RSM supplementation levels increased. However, serum T3 and T4 concentrations in lactating sows and their piglets were not affected by RSM supplementation of gestation diets. Concentrations of serum total cholesterol and low density lipoprotein cholesterol in sows were not influenced by dietary treatments, whereas serum glucose level in sows decreased linearly at d 110 of gestation (Linear, p<0.05) by increasing dietary RSM supplementation in gestation diets.

Conclusion

The RSM could be supplemented to gestation diets up to 12% with no detrimental effects on reproductive performance and growth of their progeny. However, increasing supplementation levels of RSM in gestation diets may increase serum T3 and T4 concentrations and decrease serum glucose concentration of sows in late gestation.

Double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle in a calf

A 3-day-old Hereford heifer calf presented for evaluation of lethargy and dyspnea, with persistent hypoxia despite supplemental oxygen therapy. A grade III/VI right apical systolic murmur was noted during cardiac auscultation. Echocardiography revealed a double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle and tricuspid valve dysplasia. Post-mortem examination revealed additional congenital anomalies of ductus arteriosus, patent foramen ovale, and persistent left cranial vena cava. This report illustrates the use of echocardiographic images to diagnose a double-outlet right ventricle with an intact interventricular septum and a hypoplastic left ventricle in a calf.

Evaluation of dry feeding and liquid feeding to lactating sows under high temperature environment

Background

Liquid feeding system has been introduced to domestic swine farms, but negative cognition about liquid feeding system has been remained for feed waste decay related with poor management and microbial contamination. For these reasons, this study was conducted to evaluate the effects of feeding method in lactating sows.

Methods

A total of 30 mixed-parity (average 4.13) lactating sows (Yorkshire × Landrace) with an initial BW of 218.8 ± 19.5kg was used in a 3 week trial. Sows were allotted to 1 of 2 treatments in a completely randomized design by their body weight, backfat thickness, parity and alive litter weight. One of treatments was dry feeding and the other was liquid feeding (water to feed ratio, 1:1). Experimental diets contained 3265 kcal ME/kg, 12.6 % CP, 5.76 % EE, 1.09 % total lysine, 0.25 % total methionine, as fed basis.

Results

Dry feeding treatment had high body weight loss rather than liquid feeding treatment (P = 0.04). Dry feeding treatment had tendency to increase litter weight at 21d of lactation (P = 0.06) and litter weight gain (P = 0.04) during lactation period (0–3 week). Sows fed dry feeding method made milk containing high content of casein and total solid rather than sows fed liquid feeding method (P = 0.04). In addition, dry feeding treatment had tendency to higher content of milk fat, protein and solid not fat on 21d of lactation (P = 0.07). Sows fed dry feeding type also showed higher milk energy content in milk of 21d lactation (P = 0.05). Furthermore, liquid feeding treatment showed high occurrence in feed waste during lactation period (P < 0.01).

Conclusion

Dry feeding method was more suitable feeding method to lactating sows under high temperature environment like lactating barn.

Effects of Dietary Energy Levels on the Physiological Parameters and Reproductive Performance of Gestating Gilts

This experiment was conducted to investigate the effects of dietary energy levels on the physiological parameters and reproductive performance of gestating first parity sows. A total of 52 F1 gilts (Yorkshire×Landrace) were allocated to 4 dietary treatments using a completely randomized design. Each treatment contained diets with 3,100, 3,200, 3,300, or 3,400 kcal of metabolizable energy (ME)/kg, and the daily energy intake of the gestating gilts in each treatment were 6,200, 6,400, 6,600, and 6,800 kcal of ME, respectively. During gestation, the body weight (p = 0.04) and weight gain (p = 0.01) of gilts linearly increased with increasing dietary energy levels. Backfat thickness was not affected at d110 of gestation by dietary treatments, but increased linearly (p = 0.05) from breeding to d 110 of gestation. There were no significant differences on the litter size or litter birth weight. During lactation, the voluntary feed intake of sows tended to decrease when the dietary energy levels increased (p = 0.08). No difference was observed in backfat thickness of the sows within treatments; increasing energy levels linearly decreased the body weight of sows (p<0.05) at d 21 of lactation and body weight gain during lactation (p<0.01). No significant differences were observed in the chemical compositions of colostrum and milk. Therefore, these results indicated that high-energy diets influenced the bodyweight and backfat thickness of sows during gestation and lactation. NRC (2012) suggested that the energy requirement of the gestation gilt should be between 6,678 and 7,932 kcal of ME/d. Similarly, our results suggested that 3,100 kcal of ME/kg is not enough to maintain the reproductive performance for gilts during gestation with 2 kg feed daily. Gilts in the treatment 3,400 kcal of ME/kg have a higher weaning number of piglets, but bodyweight and backfat loss were higher than other treatments during lactation. But bodyweight and backfat loss were higher than other treatments during lactation. Consequently, an adequate energy requirement of gestating gilts is 6,400 kcal of ME/d.

Step-down vs. step-up noxious stimulation: differential effects on pain perception and patterns of brain activation

BACKGROUND

We hypothesize that pain and brain responses are affected by changes in the presentation sequence of noxious stimuli that are, overall, identical in intensity and duration.

METHODS

During functional magnetic resonance imaging (fMRI) scanning, 21 participants experienced three patterns of noxious stimulation: Up-type (step-up noxious stimulation, 15 s), Down-type (step-down noxious stimulation, 15 s), and Down-up-type (decreasing and increasing pattern of noxious stimulation, 15 s). The total intensity and duration of the three noxious stimulation patterns were identical, but the stimulation sequences were different.

RESULTS

Pain and unpleasantness ratings in the Down- and Down-up-type noxious stimulations were lower than in the Up-type noxious stimulation. The left prefrontal cortex [(PFC, BA (Brodmann area) 10, (-45, 50, 1)] was more highly activated in the Down- and Down-up-type noxious stimulations than in the Up-type noxious stimulation. The S1, S2, insula, bilateral PFC (BA 46), and midcingulate cortex were more highly activated in the Up-type noxious stimulation than in the Down-type noxious stimulation. PFC BA 10 was located at an inferior level compared to the bilateral PFC BA 46 (Z axis = 1 for BA 10, compared to 22 and 25 for the right and left BA 46, respectively). When cortisol level was increased, the left hippocampal cortex, along with the left parahippocampal cortex, was greatly activated for the Up-type noxious stimulation.

CONCLUSION

When pain cannot be avoided in clinical practice, noxious stimuli should be applied to patients in a step-down pattern that delivers the most intense pain first and the least intense pain last.

Atrial Fibrillation as a Prognostic Indicator in Medium to Large-Sized Dogs with Myxomatous Mitral Valvular Degeneration and Congestive Heart Failure

Background

The prevalence and prognostic importance of atrial fibrillation (AF) on survival in nonsmall breed dogs with myxomatous mitral valvular disease (MMVD) and congestive heart failure (CHF) remain unknown.

Aim

To identify the prevalence of AF in nonsmall breed dogs with CHF because of MMVD and to characterize the impact of AF on survival outcome.

Animal

Sixty‐four client‐owned dogs (>15 kg) with MMVD and CHF.

Methods

Retrospective review of medical records for dogs weighing >15 kg with MMVD treated for CHF.

Results

Thirty‐three dogs presented with AF or developed AF during follow‐up examinations, and 31 dogs were free of AF until cardiac‐related death. For dogs with AF, median survival time (MST) was 142 days (range: 9–478) while dogs without AF lived 234 days (range: 13–879 days). AF increased risk of cardiac‐related death (HR = 2.544; 95% CI = 1.41–4.59; P = .0019) when compared to dogs without AF. MST was significantly prolonged for dogs with AF whose rates were adequately controlled (<160 bpm; 171 days; n = 13) when compared to dogs that failed to respond to negative chronotropic agents (61 days; n = 20; P = .032). The administration of combination treatment (diltiazem and digoxin) significantly decreased median HR to 144 bpm (range: 84–218 bpm) in dogs with AF and significantly prolonged MST (diltiazem+digoxin: 130 days versus diltiazem: 35 days, P = .0241) when compared to diltiazem alone.

Conclusions and Clinical Importance

Inadequately controlled AF is associated with a higher rate of mortality. Optimization of therapeutic strategies for the rate control of AF remains determined.

The Effects of Gilts Housed Either in Group with the Electronic Sow Feeding System or Conventional Stall

This experiment was conducted to assess the welfare and productivity of gestating gilts in groups with the electronic sow feeding (ESF) system compared to conventional stalls. A total of 83 gilts (Yorkshire×Landrace) were housed into individual stalls to be artificially inseminated. Gilts confirmed pregnant were introduced to their treatment, conventional stalls (ST) or groups with the ESF system. All gilts were taken to the farrowing crates one week prior to their expected farrowing date. In the gestation period, there were no significant differences between gilts allocated to ST and ESF on growth performance. However, backfat thickness gain (p = 0.08) and body condition score (BCS) at 110 days of gestation (p = 0.10) tended to be higher in ESF gilts than ST. Likewise, gilts housed in group showed significantly higher estimated body muscle contents at 110 days of gestation (p = 0.02) and body muscle change during gestation (p = 0.01). There was a trend for a shorter parturition time in ESF gilts (p = 0.07). In the lactation period, group housed gilts showed a tendency to increased BCS changes (p = 0.06). Reproductive performance did not differ with the exception of piglet mortality (ST = 0.2 no. of piglets vs ESF = 0.4 no. of piglets; p = 0.01). In blood profiles, ST gilts showed a higher cortisol level at 110 days of gestation (p = 0.01). Weaning to estrus interval was shorter in gilts housed in ESF than ST (p = 0.01). In locomotory behaviors, ESF gilts recorded a tendency to elevate locomotion score at 36, 70, and 110 days of gestation (p = 0.07, p = 0.06, and p = 0.06, respectively). Similarly, ESF gilts showed significantly higher incidence of scratches at 36, 70, and 110 days of gestation (p = 0.01). Moreover, farrowing rates were higher in stall treatment (97.6%) compare to group housing treatment (95.2%). In conclusion, while group housed gilts with ESF system positively affected welfare status in combination with less physiologically stressful environments and activity, it negatively effects piglet mortality, farrowing rates and injuries of gilts.

Does procurement technique affect posttransplant graft function in deceased donor liver transplantation?

INTRODUCTION

Various techniques have been described deceased donor liver transplantation (DDLT) procurement. One is a technique whereby almost total dissection is done in the porta hepatis and perihepatic detachment is carried out before cross-clamping the donor aorta. In another approach, after the donor aorta is cross-clamped, rapid and minimal en bloc dissection is performed with minimal manipulation. We evaluated early posttransplant graft function among liver procurement techniques.

METHOD

Between January 2008 and August 2012, we performed 45 consecutive adult DDLTs. One patient was excluded from this analysis due to early death from sepsis after transplantation. The 44 included patients were divided into two cohorts according to the procurement technique: A warm dissection (n = 23; 52%) and a cold dissection group (n = 21; 48%). We compared early posttransplant graft function using the aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (T-bil), and prothrombin time (PT) values of the two groups from the first to seventh postoperative day.

RESULT

The AST values in the warm group were significantly greater than those in the cold group on postoperative days 3 and 5. In addition, the ALT values in the warm group were greater than those in the cold group on postoperative days 4, 5, and 6. Moreover, the T-bil values in the warm group were greater than those in the cold group on postoperative days 2, 3, 4, 5, 6, and 7. However, there were no differences in PT values.

CONCLUSION

During liver procurement for DDLT, rapid en bloc procurement with minimal manipulation after clamping the donor aorta achieved better early graft function posttransplantation.

Sarcopenia and sarcopenic obesity and their association with dyslipidemia in Korean elderly men: the 2008-2010 Korea National Health and Nutrition Examination Survey

BACKGROUND

Recently, aging has been shown to be associated with sarcopenic obesity (SO), of which decreased muscle mass and increased fat mass are features. Sarcopenia and obesity alone are known to be associated with abnormal lipid metabolism. However, it remains unclear whether SO has greater adverse effects on dyslipidemia than on sarcopenia or obesity alone.

AIM

We aimed to investigate the association between SO and dyslipidemia in elderly Koreans.

SUBJECTS AND METHODS

This study was based on data collected during the 2008-2010 Korea National Health and Nutrition Examination Survey. We included 1,466 men and 2,017 women aged 65 years and over. Sarcopenia was indicated in participants with height- or weight-adjusted appendicular skeletal muscle that was 1 standard deviation below the sex-specific mean for the young reference group, and obesity was defined as a body mass index ≥ 25 kg/m(2). Dyslipidemia was defined according to the National Cholesterol Education Program-Adult Treatment Panel III.

RESULTS

After adjusting for confounding factors, the SO group had a higher risk for dyslipidemia [odds ratio (OR) 2.82 (95 % confidence interval 1.76-4.51)] than the obese group [2.12 (1.11-4.07)] and sarcopenic group [1.46 (1.01-2.11)] (p < 0.001) only in men. Furthermore, the SO group in men had the highest OR for hypercholesterolemia, hypertriglyceridemia, hypo-high-density lipoprotein cholesterolemia, hyper-low-density lipoprotein cholesterolemia, and a high ratio of triglyceride to high-density lipoprotein cholesterol even after further adjustments.

CONCLUSIONS

In Korean elderly men, SO was associated with an increased risk for dyslipidemia compared with sarcopenia or obesity alone.

Effect of Modified Atmosphere Packaging and Vacuum Packaging on Quality Characteristics of Low Grade Beef during Cold Storage

Many studies have been carried out with respect to packaging methods and temperature conditions of beef. However, the effects of packaging methods and temperature conditions on the quality characteristics have not been extensively studied in low-grade beef. Low-grade beef samples were divided into 3 groups (C: ziplock bag packaging, T1: vacuum packaging, and T2: modified atmosphere packaging (MAP), CO2/N2 = 3:7) and samples were stored at 4°C for 21 days. The water-holding capacity (WHC) was significantly lower in T1 than in the other samples up to 14 days of storage. The thiobarbituric acid reactive substances and volatile basic nitrogen values were significantly lower in T1 and T2 than in C after 7 to 14 days of storage. The total bacterial counts were significantly lower in T1 and T2 than in C after 14 days of storage. In a sensory evaluation, tenderness and overall acceptability were significantly higher in T1 and T2 than in C at the end of the storage period (21 days). We propose that the MAP method can improve beef quality characteristics of low-grade beef during cold storage. However, the beneficial effects did not outweigh the cost increase to implement MAP.

Prediction of response to entecavir therapy in patients with HBeAg-positive chronic hepatitis B based on on-treatment HBsAg, HBeAg and HBV DNA levels

Quantitative hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) assays are emerging as effective tools of on-treatment predictors of response to antiviral agents, in addition to monitoring serum HBV DNA levels. However, the dynamic relationship between quantitative HBsAg, as well as HBeAg and HBV DNA, and the predictability of subsequent clinical outcomes during entecavir (ETV) therapy remain unclear. Eighty-two patients with HBeAg-positive chronic hepatitis B (CHB) received ETV therapy for ≥3 years. Virologic response (VR) after 3 years of ETV therapy was achieved in 73 (89.0%) patients. Among baseline and on-treatment factors, on-treatment HBV DNA levels performed better with respect to the prediction of response than HBsAg and HBeAg levels. Especially, the performance of absolute values of HBV DNA with respect to response was superior to HBV DNA decline from the baseline. The best predictive value was an absolute HBV DNA level of 2.3 log(10) IU/mL at month 6 (areas under the curve [AUROC], 0.977; 95% CI, 0.940-1.000; P < 0.001). HBeAg seroconversion after 3 years of therapy was achieved in 26 (31.7%) patients. On-treatment HBeAg levels performed better with respect to the prediction of seroconversion than HBsAg and HBV DNA levels. The best cut-off value for the HBeAg level at month 12 for the prediction of seroconversion was 0.62 log(10) PEIU/mL. Although the HBsAg level at baseline is often used to predict the antiviral potency of entecavir, on-treatment HBV DNA and HBeAg levels are more helpful for prediction of subsequent clinical outcomes in HBeAg-positive CHB patients with entecavir treatment.

Prediction of response to entecavir therapy in patients with HBeAg-positive chronic hepatitis B based on on-treatment HBsAg, HBeAg and HBV DNA levels

Quantitative hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) assays are emerging as effective tools of on-treatment predictors of response to antiviral agents, in addition to monitoring serum HBV DNA levels. However, the dynamic relationship between quantitative HBsAg, as well as HBeAg and HBV DNA, and the predictability of subsequent clinical outcomes during entecavir (ETV) therapy remain unclear. Eighty-two patients with HBeAg-positive chronic hepatitis B (CHB) received ETV therapy for ≥3 years. Virologic response (VR) after 3 years of ETV therapy was achieved in 73 (89.0%) patients. Among baseline and on-treatment factors, on-treatment HBV DNA levels performed better with respect to the prediction of response than HBsAg and HBeAg levels. Especially, the performance of absolute values of HBV DNA with respect to response was superior to HBV DNA decline from the baseline. The best predictive value was an absolute HBV DNA level of 2.3 log(10) IU/mL at month 6 (areas under the curve [AUROC], 0.977; 95% CI, 0.940-1.000; P < 0.001). HBeAg seroconversion after 3 years of therapy was achieved in 26 (31.7%) patients. On-treatment HBeAg levels performed better with respect to the prediction of seroconversion than HBsAg and HBV DNA levels. The best cut-off value for the HBeAg level at month 12 for the prediction of seroconversion was 0.62 log(10) PEIU/mL. Although the HBsAg level at baseline is often used to predict the antiviral potency of entecavir, on-treatment HBV DNA and HBeAg levels are more helpful for prediction of subsequent clinical outcomes in HBeAg-positive CHB patients with entecavir treatment.

Tianeptine vs amitriptyline for the treatment of irritable bowel syndrome with diarrhea: a multicenter, open-label, non-inferiority, randomized controlled study

BACKGROUND

Tricyclic antidepressants have good efficacy in irritable bowel syndrome with diarrhea (IBS-D), but their clinical use is limited by considerations of tolerability. Tianeptine, another antidepressant, acts as a selective serotonin reuptake enhancer. We compared tianeptine with amitriptyline for the treatment of patients with IBS-D.

METHODS

We undertook a multicenter, randomized, open-label, non-inferiority clinical study that compared tianeptine with amitriptyline, each in combination with probiotics, for the treatment of IBS-D. Subjects were randomized to receive tianeptine (37.5 mg)/probiotics (Bacillus subtilis + Streptococcus faecium) or amitriptyline (10 mg)/probiotics (Bacillus subtilis + Streptococcus faecium) for 4 weeks. A total of 228 patients were analyzed by the intention-to-treat approach. The primary efficacy endpoint was the proportion of patients who had global relief of IBS symptoms at week 4. The secondary efficacy endpoints were intensity of abdominal pain/discomfort, stool frequency/consistency, quality of life, and overall satisfaction with treatment.

KEY RESULTS

At week 4, non-inferiority of the tianeptine group to the amitriptyline group (treatment difference -15.1%; 95% CI -26.6% to -3.8%) was shown, with 81.1% (99 of 122 patients) of the patients in the tianeptine group and 66.0% (70 of 106 patients) in the amitriptyline group reporting global relief of IBS symptoms. The secondary endpoints also demonstrated non-inferiority of the tianeptine group to the amitriptyline group. Adverse events such as dry mouth and constipation were significantly lower in the tianeptine group than the amitriptyline group (P<0.05).

CONCLUSIONS & INFERENCES

Tianeptine is not inferior to amitriptyline for treating IBS-D in terms of both efficacy and tolerability.

Standardization of modified right lobe grafts to minimize vascular outflow complications for adult living donor liver transplantation

BACKGROUND

After >2000 adult living donor liver transplants (LDLTs), we observed minimization of the complication rate using case-by-case modification of venous outflow reconstruction in right liver graft (RLG), standardization seeking intend to provide a hemodynamic- based, regeneration-compliant hepatic outflow reconstruction.

METHODS

We retrospectively examined 100 consecutive adult LDLT using modified RLG before and after application of RLG standardization to compare the 6-month incidences of vascular outflow complications.

RESULT

The right hepatic vein stenting rate for first 6 months was 5% in the customized group and 1% in the standardized group (P=.212). The middle hepatic vein stenting rate for first 6 months was 9% in the customized group and 4% in the standardized group (P=.373). The inferior right hepatic vein stenting rate for first 6 months was 12.8% in the customized group and 7.1% in the standardized group (P=.472). The overall 6-month patient survival rate was 94% in the customized group and 95% in the standardized group (P=.867). The overall incidence of significant RLG venous outflow complications was 19% in the customized group and 8% in the standardized group (P=.023).

CONCLUSION

Standardization as a universal graft model seemed to be more effective and feasible than conventional graft customization requiring individualized case-by-case modification.

Optimization of selective emitter fabrication method for solar cells using a laser grooving

In this paper, screen-printing laser grooved buried contact (LGBC) method was applied, which is compatible with the existing screen-printed solar cell equipment and facilities. Experiments were performed in order to optimize short circuit current (I(sc)), open circuit voltage (V(oc)) and fill factor of high efficiency solar cells. To enhance I(sc), V(oc) and efficiency, heavy doping was performed at low sheet resistance in the laser grooved region of the cell. In contrast, light doping was carried out at a high sheet resistance in the non-laser grooved region. To increase fill factor, porous silicon found on the wafer after dipping in an HF solution to remove SiN(x), was cleared. The fabricated screen-printing LGBC solar cell using a 125 mm x 125 mm single crystalline silicon wafer exhibited an efficiency of 17.2%. The results show that screen-printing LGBC method can be applied for high efficiency solar cells.

Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial

BACKGROUND AND STUDY AIMS

Although endoscopic ultrasound (EUS)-guided transmural drainage (EUD) is preferred over conventional transmural drainage (CTD) of pancreatic pseudocysts by endoscopy in many centers, its superiority with respect to technical success and clinical outcome has not yet been demonstrated in a prospective randomized trial. We conducted this prospective randomized trial to compare the technical success and clinical outcomes of EUD and CTD in treating pancreatic pseudocysts.

PATIENTS AND METHODS

A total of 60 consecutive patients with pancreatic pseudocysts were randomly divided into two groups to undergo either EUD (n = 31) or CTD (n = 29) of pancreatic pseudocysts. The technical success rate, complications, and short-term and long-term results were prospectively evaluated.

RESULTS

The rate of technical success of the drainage was higher for EUD (94 %, 29/31) than for CTD (72 %, 21/29; P = 0.039) in intention-to-treat analysis. In cases where CTD failed (n = 8), because the pseudocysts were nonbulging, a crossover was made to EUD, which was successfully performed in all these patients. Complications occurred in 7 % of the EUD and 10 % of the CTD group ( P = 0.67). During short-term follow-up, pseudocyst resolution was achieved in 97 % (28/29) in the EUD group and in 91 % (19/21) in the CTD group ( P = 0.565). Long-term results analyzed on a per-protocol basis showed no significant difference in clinical outcomes between EUD (89 %, 33/37) and CTD (86 %, 18/21, P = 0.696).

CONCLUSIONS

We found that EUD and CTD can both be considered first-line methods of endoscopic transmural drainage of bulging pseudocysts, whereas EUD should be preferred for nonbulging pseudocysts.

Efficacy of Helicobacter pylori eradication therapy in chronic liver disease

BACKGROUND/AIMS

Peptic ulcers occur more commonly in patients with liver cirrhosis (LC). Helicobacter pylori is recognized as the most important etiology in the pathogenesis of peptic ulcers. We investigated the efficacy of proton pump inhibitor (PPI)-based triple therapy in patients with chronic liver disease and peptic ulcer.

PATIENTS AND METHODS

One hundred sixty-three patients with LC or chronic hepatitis (CH) with a peptic ulcer and proven H. pylori infection were included. The combination of PPI, amoxicillin (1.0 g), and clarithromycin (500 mg), each given twice daily, was administered for 1 or 2 weeks. The eradication of H. pylori was determined by the rapid urease test, histology, or the 13C-urea breath test at least 4 weeks after completing the treatment.

RESULTS

The eradication rate of H. pylori was similar between the LC and CH groups; 82.6% and 88.1%, respectively. In addition, there were no significant differences in eradication rates between the patients with Child-Pugh class A and Child-Pugh class B/C disease. The side effects in each group were generally mild. Only the serum ALT levels showed a significant correlation with the success of H. pylori eradication in both the LC and CH groups.

CONCLUSION

The PPI-based triple therapy achieves high eradication rates for H. pylori infection, in patients with chronic liver disease, without significant side effects.

Expression of N-methyl-d-aspartate receptor 1 in rats with chronic ocular hypertension

High levels of glutamate can be toxic to retinal ganglion cells (RGCs). This study investigated the relationship between the N-methyl-d-aspartate receptor 1 (NR) and RGC death in a rat model of chronic ocular hypertension (COHT). COHT was induced in one eye of each rat by episcleral vein cauterization. Retinal protein expression was evaluated at 1, 3, 5 and 9 weeks after cauterization. Quantitative real-time polymerase chain reaction and Western blot analysis showed that NR1 expression was significantly increased in cauterized retinae. NR1 immunoreactivity was observed in the inner nuclear layer (INL) and ganglion cell layer (GCL) in the retina of rats with COHT. RGC density was evaluated after retrograde labeling with fluoro-gold (FG) and 4-di-10-ASP (DiA). A significant decrease in RGC density was observed in ocular hypertensive eyes, and NR1 expression in the GCL suggested an important role of NR1 in the death of RGCs. Memantine (10 mg/kg), an N-methyl-d-aspartate receptor antagonist, was administered orally once daily for up to 5 weeks, while rats in the control group received vehicle phosphate-buffered saline only. Treatment with memantine resulted in a significant reduction in RGC loss and NR1 expression in the eyes of rats COHT. These findings suggest that excessive expression of NR1 is involved in RGC death in glaucoma.

Limits on interactions between weakly interacting massive particles and nucleons obtained with CsI(Tl) crystal detectors

The Korea Invisible Mass Search (KIMS) experiment presents new limits on the weakly interacting massive particle (WIMP)-nucleon cross section using data from an exposure of 3409 kg.d taken with low-background CsI(Tl) crystals at the Yangyang Underground Laboratory. The most stringent limit on the spin-dependent interaction for a pure proton case is obtained. The DAMA signal region for both spin-independent and spin-dependent interactions for the WIMP masses greater than 20 GeV/c2 is excluded by the single experiment with crystal scintillators.

Endoscopic removal of biliary self-expandable metallic stents: a prospective study

BACKGROUND AND STUDY AIMS

The transpapillary endoscopic insertion of self-expandable metallic stents (SEMSs) has been widely used for the palliation of unresectable malignant biliary obstruction. We attempted the endoscopic removal of malfunctioning SEMSs. The aim of this study was to assess the feasibility and safety of the endoscopic removal of SEMSs by comparing the results between removal of covered and uncovered SEMSs.

PATIENTS AND METHODS

30 patients with a malfunctioning biliary SEMS prospectively underwent an attempt at endoscopic removal of the biliary SEMS over a 2-year period. Removal of the malfunctioning SEMS was done with a therapeutic duodenoscope (ED-450XT5 or TJF-240), using a rat-tooth forceps. Of the 30 SEMS used, 22 were silicone-covered Wallstents, while eight were uncovered SEMSs including five uncovered Wallstents and three Zilver stents. The time for an attempt at each endoscopic removal was limited to 15 minutes in a single endoscopic procedure session.

RESULTS

The covered SEMSs were easily removed in 19 out of 22 patients (86.4 %), whereas none of the eight uncovered SEMSs (0 %) could be removed. The only factor predicting successful stent removal was the presence of a stent covering ( P = 0.000). There was no morbidity or mortality related to endoscopic removal of malfunctioning stents.

CONCLUSIONS

In contrast to uncovered biliary SEMSs, in most cases malfunctioning covered biliary SEMSs can be easily and safely removed endoscopically using a rat-tooth forceps.

Endoscopic removal of biliary self-expandable metallic stents: a prospective study

BACKGROUND AND STUDY AIMS

The transpapillary endoscopic insertion of self-expandable metallic stents (SEMSs) has been widely used for the palliation of unresectable malignant biliary obstruction. We attempted the endoscopic removal of malfunctioning SEMSs. The aim of this study was to assess the feasibility and safety of the endoscopic removal of SEMSs by comparing the results between removal of covered and uncovered SEMSs.

PATIENTS AND METHODS

30 patients with a malfunctioning biliary SEMS prospectively underwent an attempt at endoscopic removal of the biliary SEMS over a 2-year period. Removal of the malfunctioning SEMS was done with a therapeutic duodenoscope (ED-450XT5 or TJF-240), using a rat-tooth forceps. Of the 30 SEMS used, 22 were silicone-covered Wallstents, while eight were uncovered SEMSs including five uncovered Wallstents and three Zilver stents. The time for an attempt at each endoscopic removal was limited to 15 minutes in a single endoscopic procedure session.

RESULTS

The covered SEMSs were easily removed in 19 out of 22 patients (86.4 %), whereas none of the eight uncovered SEMSs (0 %) could be removed. The only factor predicting successful stent removal was the presence of a stent covering ( P = 0.000). There was no morbidity or mortality related to endoscopic removal of malfunctioning stents.

CONCLUSIONS

In contrast to uncovered biliary SEMSs, in most cases malfunctioning covered biliary SEMSs can be easily and safely removed endoscopically using a rat-tooth forceps.

Dielectrophoretic alignment of gallium nitride nanowires (GaN NWs) for use in device applications

We report on a simple and effective ac and dc dielectrophoresis (DEP) method that can be used to align and manipulate semiconductor gallium nitride (GaN) nanowires (NWs) with variations in the type of electrical fields as well as variations of frequency. We observed that the ability of the alignment and the formation of the assembling nanowires (single or a bundle configuration) strongly depend on the magnitude of both the ac and dc electric fields. The yield results indicate that the GaN NWs, using ac DEP, are better aligned with a higher yield rate of approximately 80% over the entire array in the chip than by using dc DEP. In addition, we first demonstrated the simple hybrid p-n junction structures assembled by n-type GaN nanowires together with a p-type silicon substrate (n-GaN NW/p-Si substrate) using dielectrophoresis. From the transport measurements, the p-n junction structures show well-defined current rectifying behaviour with a low reverse leakage current of approximately 3 x 10(-4) A at -25 V. We believe that our unique p-n junction structures can be useful for electronic and optoelectronic nanodevices such as rectifiers and UV nano-LEDs.

Treatment of taste and odor material by oxidation and adsorption

Massive blooms of blue-green algae in reservoirs produce the musty-earthy taste and odor, which are caused by compounds such as 2-MIB and geosmin. 2-MIB and geosmin are rarely removed by conventional water treatment. Their presence in the drinking water, even at low levels (ng/L), can be detected and it creates consumer complaints. So those concentrations have to be controlled as low as possible in the drinking water. The removals by oxidation (O3, Cl2, ClO2) and adsorption (PAC, filter/adsorber) were studied at laboratory and pilot plant (50 m3/d) to select suitable 2-MIB and geosmin treatment processes. The following conclusions were derived from the study. Both of the threshold odor levels for 2-MIB and geosmin appeared to be 30 ng/L as a consequence of a lab test. For any given PAC dosage in a jar-test, removal efficiencies of 2-MIB and geosmin were increased in proportion to PAC dosage and were independent of their initial concentration in raw water for the tested PAC dosages. In comparison of geosmin with 2-MIB, the adsorption efficiency of geosmin by PAC was superior to that of 2-MIB. The required PAC dosages to control below the threshold odor level were 30 mg/L for geosmin and 50 mg/L for 2-MIB at 100 ng/L of initial concentration. Removal efficiencies of odor materials by Cl2, ClO2, and O3 were very weak under the limited dosage (1.5 mg/L), however increased ozone dosage (3.8 mg O3/L) showed high removal efficiency (84.8% for 2-MIB) at contact time 6.4 minutes. According to the initial concentrations of 2-MIB and geosmin, their removal efficiencies by filter/adsorber differed from 25.7% to 88.4%. For all those, however, remaining concentrations of target materials in finished waters were maintained below 30 ng/L. The longer run-time given for the filter/adsorber, the higher the effluent concentration generated. So it is necessary that the run-time of the filter/adsorber be decreased, when 2-MIB or geosmin occurs in raw water.

Intracranial ictal onset zone in nonlesional lateral temporal lobe epilepsy on scalp ictal EEG

OBJECTIVE

To determine the ictal focus and the role of seizure characteristics, fluorodeoxyglucose (FDG) PET, and subtraction ictal SPECT in patients diagnosed as having nonlesional lateral temporal lobe epilepsy by long-term scalp video-EEG monitoring.

METHODS

The authors studied 33 consecutive patients with nonlesional neocortical epilepsy who had a scalp ictal onset zone localized in the temporal lobe and good surgical outcome after focal neocortical resection. All patients were evaluated using intracranial recordings prior to resection. Semiology, FDG-PET, and ictal-interictal subtraction SPECT were used to verify the diagnostic role of these methods in the localization of epileptic foci.

RESULTS

The ictal onset zones, confirmed by intracranial study, were the lateral temporal (22 patients), parietal (5), frontal (3), temporoparietal (2), and occipital (1) areas. FDG-PET analyzed by statistical parametric mapping correctly localized the epileptogenic lobe in 18 of 33 patients and subtraction ictal SPECT correctly localized it in 13 of 25 patients. However, in patients with extratemporal ictal onset zones, FDG-PET and ictal SPECT in combination correctly localized the epileptogenic lobe in only 3 of 11 cases.

CONCLUSIONS

An extratemporal ictal onset zone was encountered in patients with nonlesional lateral temporal lobe seizures based on scalp video-EEG monitoring. FDG-PET and subtraction SPECT had localizing value in no more than half of patients.

Intracranial ictal onset zone in nonlesional lateral temporal lobe epilepsy on scalp ictal EEG

OBJECTIVE

To determine the ictal focus and the role of seizure characteristics, fluorodeoxyglucose (FDG) PET, and subtraction ictal SPECT in patients diagnosed as having nonlesional lateral temporal lobe epilepsy by long-term scalp video-EEG monitoring.

METHODS

The authors studied 33 consecutive patients with nonlesional neocortical epilepsy who had a scalp ictal onset zone localized in the temporal lobe and good surgical outcome after focal neocortical resection. All patients were evaluated using intracranial recordings prior to resection. Semiology, FDG-PET, and ictal-interictal subtraction SPECT were used to verify the diagnostic role of these methods in the localization of epileptic foci.

RESULTS

The ictal onset zones, confirmed by intracranial study, were the lateral temporal (22 patients), parietal (5), frontal (3), temporoparietal (2), and occipital (1) areas. FDG-PET analyzed by statistical parametric mapping correctly localized the epileptogenic lobe in 18 of 33 patients and subtraction ictal SPECT correctly localized it in 13 of 25 patients. However, in patients with extratemporal ictal onset zones, FDG-PET and ictal SPECT in combination correctly localized the epileptogenic lobe in only 3 of 11 cases.

CONCLUSIONS

An extratemporal ictal onset zone was encountered in patients with nonlesional lateral temporal lobe seizures based on scalp video-EEG monitoring. FDG-PET and subtraction SPECT had localizing value in no more than half of patients.

Vestibular diagnosis as prognostic indicator in sudden hearing loss with vertigo

The majority of episodes of sudden hearing loss are caused by inner ear disorders, often accompanied by vertigo. The patterns of hearing loss usually influence the prognosis. The purpose of this study was to analyze vestibular diagnoses in sudden hearing loss with vertigo, and to correlate them with the recovery of hearing loss. The clinical records of 125 patients with sudden hearing loss were reviewed. Various vestibular evaluations were performed in 36 patients with vertigo. The vertigo in these patients was classified as normal, unilateral hypofunction, directional preponderance, benign paroxysmal positional vertigo (BPPV), non-specific or irritative. The initial and final pure-tone audiograms of these patients were compared. The distribution of vestibular diagnoses was unilateral hypofunction in 30.6% of patients, BPPV in 25.7%, normal in 19.4%, non-specific in 11.1%, directional preponderance in 8.3% and irritative in 8.3%. The recovery of hearing in patients with vertigo was significantly worse than in those without vertigo. The recovery of hearing in patients with spinning vertigo did not differ from that of patients with non-spinning vertigo. The recovery of hearing was worst in the BPPV group, especially in the high frequency range, followed by the unilateral hypofunction group, who showed hearing thresholds between those in the BPPV group and those in the normal vestibular function test group. This study suggests that the diagnostic classification of vestibulopathy is a useful prognostic indicator of hearing recovery in sudden hearing loss with vertigo. We conclude that otolithic and semicircular canal involvement may cause poor hearing results, especially in the high frequency range.

Effect of allergina on mast cell-mediated allergic reactions

The herbal formulation ALLERGINA has been used against allergic inflammation disease for generations, and still occupies an important place in traditional medicine in Korea. In this study, we investigated the effect of ALLERGINA by oral administration in mast cell-mediated anaphylaxis responses. ALLERGINA dose-dependently inhibited compound 48/48-induced systemic anaphylaxis with doses of 10(-2) to 5 g/kg 1 h before orally administered. Of special note, ALLERGINA inhibited systemic anaphylaxis completely with doses of 1 g/kg and 5 g/kg. ALLERGINA (1 g/kg) also inhibited passive cutaneous anaphylaxis by 84%. ALLERGINA dose-dependently inhibited histamine release from rat peritoneal mast cells. When ALLERGINA (0.01 mg/ ml) was added, ALLERGINA inhibited the production of tumor necrosis factor-alpha and interleukin-6, 80% and 26%, respectively in anti-dinitrophenyl IgE antibody-stimulated mast cells. Our studies provide evidence that ALLERGINA may be beneficial in the treatment of allergic inflammation diseases.

A triterpene glucosyl ester from the roots of Rubus crataegifolius

Along with five known triterpene glycosides, a new triterpene glucosyl ester, named crataegioside, was isolated from the roots of Rubus crataegifolius Bunge. The structure was established as ilexosapogenin A 28-O-beta-D-glucopyranosyl ester by chemical and spectroscopic methods.

Sinonasal tuberculosis associated with osteomyelitis of the ethmoid bone and cervical lymphadenopathy

Sinonasal tuberculosis is a rare disease; its association with osteomyelitis of surrounding bone and cervical lymphadenopathy has been reported rarely. In this article, we report a case of sinonasal tuberculosis that was complicated by osteomyelitis of the ethmoid bone and cervical lymphadenopathy. Infection of the bone was demonstrated by biopsy and (99m)Tc-MDP bone single photon emission computed tomography (SPECT), and cervical lymphadenopathy was confirmed by histology. This case will be discussed with specific emphasis on the imaging characteristics.

A Case of Primary MALT Lymphoma of the Breast

Primary malignant lymphoma of the breast is rare. The incidence of primary malignant lymphomas of the breast is 0.04% to 0.5% of all malignant tumors of the breast and 0.07% of all non-Hodgkin's lymphomas, and comprises 1.7% of extranodal malignant lymphomas that occur in Western countries. The incidence of mucosa- associated lymphoid tissue (MALT) lymphoma of the breast is reported to be between 0% and 75% of all primary malignant breast lymphomas in United States and Japan, but the incidence in Korea is unknown. MALT is characterized by indolent behavior and good has a prognosis. The authors report on a patient who has a primary MALT lymphoma of the breast. She was treated by surgical excision, which was followed by radiation therapy. Histologically, her lymphoma type transformed into a diffuse large B-cell tumor after 10months. She received combination chemotherapy and achieved a complete state of remission. She then underwent autologous peripheral blood stem cell transplantation along with high dose chemotherapy. To our knowledge, this is the first case report in the literature in Korea.

Novel transglutaminase inhibitors reduce the cornified cell envelope formation

Transglutaminase (TGase) is a calcium-dependent enzyme which catalyzes the iso-peptide cross-link between peptide-bound glutamine and lysine in vivo. Though the cross-link is developed as a barrier function in the skin system, overexpression of this could invoke skin hyperkeratosis in psoriasis and roughness in aged skin. In former research, many strong irreversible TGase inhibitors failed application because of high cytotoxicity. We selected one peptide after primary screening of six synthetic peptides designed from domains of known TGase substrates. Then we attempted to reduce the size and finally obtained two tetrameric peptides. When we treated keratinocyte with these TGase inhibitors under calcium-induced differentiation, the formation of a cornified cell envelope (CE) was decreased to the same level of CE under proliferating conditions without cytotoxic effect. Therefore, we propose that these TGase inhibitors may be useful for solving the physiological hypercross-linking problems for pharmaceutical or cosmetic purposes.

Optical implementation of the Hopfield model for two-dimensional associative memory

Optical implementation of Hopfield's neural network model [Proc. Natl. Acad. Sci. USA 79, 2554 (1982)] for two-dimensional associative memory is discussed. Two-state neuron elements are represented by a twisted nematic liquid-crystal optical switch array, and three-dimensional holographic interconnections are realized with these elements. Unipolar connections, created by adding a constant to bipolar interconnections and compensating them with an input-dependent thresholding operation, are realized. The 16- (4 x 4) neuron system model acts as a content-addressable associative memory with error-correction capability.