Effect of Clubbell Training on Glenohumeral Internal and External Rotation, Muscle Function, and Ball Velocity in Baseball Pitchers

OBJECTIVES This study examined the effects of clubbell exercises in a pitcher training program on the range of motion (ROM), muscle function, and its subsequent influence on pitching velocity. Additionally, this study aimed to develop an optimal training program to prevent injury while improving pitcher performance.METHODS Eighteen pitchers were included and equally divided into clubbell exercise and control groups. Clubbell training was conducted through 60-minute sessions twice a week for 12 weeks. Internal/external rotational (IR/ER) ROM, IR/ER muscle strength, muscle endurance, muscle power, and pitching velocity were measured before and after the intervention.RESULTS The IR (<i>p</i> = 0.051) and total ROM (TROM; <i>p</i> = 0.05) of the throwing arm decreased in the control group but increased in the clubbell exercise group, with an observed tendency of interaction. In the non-throwing arm, the ER ROM was significantly different between the two groups (<i>p</i> <0 .05), also with an observed tendency of interaction (<i>p</i> = 0.055). IR peak torque per body weight at 60°/sec significantly increased in both groups over the exercise period (<i>p</i> < 0.01). Total work per body weight and average power of IR at 180°/sec increased in both groups over the exercise period (<i>p</i> < 0.01). The pitching velocity decreased in both groups throughout the exercise period (<i>p</i> < 0.05).CONCLUSIONS Although 12 weeks of clubbell training had limited effects on ROM, the findings revealed that this exercise could be effective in improving pitching performance, preventing injuries, and maintaining long-term performance. Further studies are recommended for a more detailed assessment.

Changes in Muscle Activity among College Pitchers Using 5- to 12-Oz Weighted Baseball

OBJECTIVES Several studies have reported that weighted baseball (WB) training is effective in improving ball speed; however, the weight of the ball suitable for training remains unclear. This study aimed to investigate the changes in muscle activity during pitching using 5- to12-oz WBs and to provide basic data for training programs to improve pitching speed.METHODS The subjects of this study were 10 overhand pitchers who had more than 5 years of experience. Muscle activity was measured and analyzed at 70–85% of throwing baseball maximum effort (TBME) during soft toss (ST) and TBME was evaluated using electromyography.RESULTS As the ball weight increased, muscle activity also increased in all pitching phases. Muscle activity was higher during ST with WBs heavier than 10 or 11oz than during TBME, indicating that the loads on the shoulder and elbow joint muscles increased. Conversely, muscle activity during ST with 5- to 7-oz WBs was lower than that during TBME, although phase and muscle group differences were observed.CONCLUSIONS The results of this study suggest that training with 8- to 10-oz WBs could increase muscle strength and activity, although the effect may vary with fitness level and muscle strength.

Comparison of the efficacy and safety of CELBESTA® versus CELEBREX® in patients with rheumatoid arthritis: a 6-week, multicenter, double-blind, double-dummy, active-controlled, randomized, parallel-group, non-inferiority phase 4 clinical trial

Objectives

Celecoxib is a selective cyclooxygenase (COX)-2 inhibitor that is commonly used to reduce the incidence of gastrointestinal (GI) complications in patients with rheumatoid arthritis (RA). CELBESTA® is a generic equivalent to CELEBREX®, a celecoxib preparation. This study compared the efficacy and safety of CELBESTA® and CELEBREX® in patients with RA.

Methods

This was a multicenter, double-blind, double-dummy, active-controlled, randomized, parallel-group, non-inferiority clinical trial. The primary endpoint was a change from baseline in self-assessed pain intensity determined using a 100-mm visual analog scale after 6 weeks of treatment.

Results

After a washout period, 119 eligible subjects were randomized to one of two groups (CELBESTA® group, n = 61; CELEBREX® group, n = 58). CELBESTA® was not inferior to CELEBREX® because the upper limit of two-sided 95% confidence interval (CI) for the difference between the two groups (difference in the least square [LS] mean, −8.68 mm; two-sided 95% CI −16.59 mm to −0.77 mm) was less than the non-inferiority margin (10 mm). There were no significant differences in GI complications and renal toxicity.

Conclusions

CELBESTA® was not inferior to CELEBREX® with regard to the pain relief efficacy in RA patients, and the tolerability and safety profiles were excellent and at similar levels for both preparations.

Prospective randomized comparison of cerebrospinal fluid aspiration and conventional popping methods using 27-gauge spinal needles in patients undergoing spinal anaesthesia

Background

Performing spinal anaesthesia using the conventional popping method with a 27-gauge (27G) spinal needle is technically difficult. In this study, we compared the aspiration and conventional popping method for spinal anaesthesia using 27G Quincke-type needles.

Methods

This prospective, randomized study enrolled 90 patients, aged 19 to 65 years, with American Society of Anesthesiologists physical status I-III, who were undergoing spinal anaesthesia. Patients were randomly assigned to one of two groups using a computer-generated random number table: patients receiving spinal anaesthesia using the aspiration method, in which the needle is advanced with continuous aspiration, or the conventional popping method. The primary outcome measure was the success rate of the first attempt to perform dural puncture. Number of attempts and passages, withdrawal cases, successful attempt time, total procedure time, and actual depth of dural puncture were recorded.

Results

Eighty-eight patients were included in the study. In the aspiration group, the success rate of first attempt for dural puncture was 93.3%, compared with 72.1% in the popping group (P = 0.019). Success involving needle withdrawal was recorded in 4 (8.9%) patients in the aspiration group and 13 (30.2%) in the popping group (P = 0.024). In the popping group, the number of attempts was significantly higher (P = 0.044), and total procedure time was significantly longer (P = 0.023). Actual depths of dural puncture were deeper in the popping group than in the aspiration group (P = 0.019).

Conclusions

The aspiration method using a 27G Quincke-type needle offers clinical benefits for dural puncture compared with the conventional popping method for spinal anaesthesia.

Trial registration

Clinical research information service number: KCT0002815, registered 21/Apr/2018. Retrospectively registered.

Effects of weighted baseball throwing during warm-up on ball velocity and upper extremity muscle activation in baseball pitchers

The objective of this study was to investigate the changes in the muscle activation of high school and college baseball pitchers during throwing of the ball with maximum effort (TBME) using a regular baseball (RB) subsequent to using a light baseball (LB), RB, and overweight baseball (OB) during warm-up (WU) and the resulting changes in the pitch velocity. The study aimed to use the findings in providing basic data for a training program designed to increase the pitch velocity of baseball pitchers. The study population consisted of 12 high school and college baseball players. The study measured and analyzed the upper extremity muscle activation and ball velocity in the stride, arm cocking, and acceleration phases during TBME using an RB subsequent to using an LB, RB, and OB during WU. During WU, the ball velocity was higher when pitching with an LB than with an RB or OB and when pitching with an RB than with an OB. However, there were no significant differences in the ball velocity when pitching with an RB during TBME. In conclusion, WU using weighted baseballs resulted in varying muscle activations, and although the velocity decreased when pitching with an OB, no difference was found during TBME using an RB. Therefore, it is believed that using weighted baseballs during WU does not have an effect on the ball velocity during TBME; future studies are needed on the effects through long-term training.

Effects of virtual reality intervention on upper limb motor function and activity of daily living in patients with lesions in different regions of the brain

[Purpose] This study aimed to investigate whether a virtual reality (VR) intervention has an influence in improving the motor function and activities of daily living (ADLs) in patients with lesions in different regions of the brain. [Subjects and Methods] Eleven subjects with hemiplegic stroke were recruited in this study, which was conducted from January to February, 2017. They received a VR intervention once a day for 30 min, 5 times a week for 4 weeks. The Fugl-Meyer Assessment (FMA) and the Korean version of the Modified Barthel Index (K-MBI) were used to assess the post-stroke patients’ motor function and ADLs, respectively. [Results] There were significant differences in pre- and post-test outcomes of the Arm and Coordination and Speed (CS) in the FMA and K-MBI in the middle cerebral artery group (MCAG). Moreover, there were significant differences in all sub-tests of FMA and K-MBI in the Basal ganglia group (BGG). In addition, there were significant differences in the pre-test outcomes of Arm and pre- and post-test outcomes of Hand in the FMA between the two groups. [Conclusion] This study revealed that VR intervention improved the upper limb motor function and ADLs of post-stroke patients, especially those in the BGG.

Effects of repeated vibratory stimulation of wrist and elbow flexors on hand dexterity, strength, and sensory function in patients with chronic stroke: a pilot study

[Purpose] The aim of this study was to investigate the effects of repeated vibratory stimulation to muscles related to hand functions on dexterity, strength, and sensory function in patients with chronic stroke. [Subjects and Methods] A total of 10 stroke patients with hemiplegia participated in this study. They were divided into two groups: a) Experimental and b) Control, with five randomly selected subjects for each group. The experimental group received vibratory stimulation, while the control group received the traditional physical therapy. Both interventions were performed for 30 minutes each session, three times a week for four weeks. [Results] There was a significant within-group improvement in the box and block test results in both groups for dexterity. Grip strength improved in both groups but the improvement was not statistically significant. [Conclusion] The vibratory stimulation activated the biceps brachii and flexor carpi radialis, which increased dexterity to grasp and lift the box and block from the surface. Therefore, repeated vibratory stimulation to muscles related to hand functions improved hand dexterity equality to the traditional physical therapy in patients with chronic stroke.

Clinical Relevance of Poststent Fractional Flow Reserve After Drug-Eluting Stent Implantation

BACKGROUND

The prognostic value of poststent fractional flow reserve (FFR) has not been clearly defined in patients with drug-eluting stent (DES) implantation. This study sought to evaluate the association between FFR and clinical outcomes after DES implantation with intravascular ultrasound (IVUS) assistance.

METHODS

A total of 115 lesions (107 patients) with FFR measurement after IVUS-assisted DES implantation were enrolled. Poststent angiographic and IVUS parameters were compared with FFR values. Clinical outcomes were assessed by target vessel failure (TVF), defined as a composite of target vessel revascularization, death, or non-fatal myocardial infarction attributed to the target vessel.

RESULTS

Mean poststent FFR was 0.92 ± 0.04. Minimal stent area by IVUS had a positive correlation with poststent FFR (r = 0.36; P<.01). Poststent FFR ≥0.89 was a physiologic cut-off value for 1-year TVF-free survival. The best cut-off value of minimal stent area to define poststent FFR ≥0.89 was >5.4 mm² (sensitivity, 63.2%; specificity, 90.0%). At 3-year follow-up, lesions with poststent FFR ≥0.89 had a better TVF-free survival rate than those with poststent FFR <0.89 (89.3% vs 61.1%, P =.03).

CONCLUSION

Poststent FFR can be a useful predictor for long-term clinical outcomes after DES implantation and relevant to IVUS minimal stent area.

A study on the effect of self bedside exercise program on resilience and activities of daily living for patients with hemiplegia

The purpose of this study was to design a repeatable universal rehabilitation program in which patients with hemiplegia can participate voluntarily, complementing physical and occupational therapies to increase voluntary exercise practice rate. Also, this study attempted to identify the relationship between psychological resilience due to the implementation of self-bedside exercise and functional recovery of activity of daily living (ADL). 12 patients with hemiplegia voluntarily participated in 8 weeks of self-bedside exercise 5 times a day and more than 5 days a week. Their program implementation, resilience, activities of daily living (MBI), upper limb motor functions (MFT), and balance ability (BBS) were analyzed and compared before and after the program. Compared to before implementing the program, significant increases were found in resilience, MBI, BBS, and MFT in the affected side after the implementation, and the resilience scores showed statistically positive correlation in MBI and MFT. Also, the change in resilience before and after the program implementation showed a statistically positive correlation. Therefore, it can be concluded that the self-bedside exercise developed in this study had a positive effect on voluntary participation in exercise as well as resilience and ADL. However, many studies which complement the psychological aspects of hemiparetic patients with stroke are still needed.

Physical activity recognition based on rotated acceleration data using quaternion in sedentary behavior: a preliminary study

This paper suggests a physical activity assessment method based on quaternion. To reduce user inconvenience, we measured the activity using a mobile device which is not put on fixed position. Recognized results were verified with various machine learning algorithms, such as neural network (multilayer perceptron), decision tree (J48), SVM (support vector machine) and naive bayes classifier. All algorithms have shown over 97% accuracy including decision tree (J48), which recognized the activity with 98.35% accuracy. As a result, physical activity assessment method based on rotated acceleration using quaternion can classify sedentary behavior with more accuracy without considering devices' position and orientation.

New and effective multi-element alpha-hematite systems for reduction of trichloroethylene

The reactivity of different alpha-hematite (alpha-Fe203) systems for dechlorination of trichloroethylene (TCE) in the presence of Fe(II) and CaO was investigated. Initially different experiments were conducted to investigate the reactivity of pure and doped alpha-Fe203. It was found that the presence of elements such as Si, Cu, and Mn in alpha-Fe203 had a significant effect on TCE reduction potential of alpha-Fe203; however, the reduction potential was less than that of alpha-Fe203 (Bayferrox- 110 M, used in a previous study). Further studies were carried out and alpha-Fe203 was synthesized in a manner similar to that of Bayferrox-110 M. This synthetic alpha-Fe203 showed improved reactivity and was found to follow pseudo-first-order kinetics when used in TCE reduction experiments. The preliminary end products analysis showed that TCE degradation was probably via beta-elimination pathway. Detailed investigations ofa-Fe203 systems were carried out using X-ray diffraction, X-ray fluorescence, and scanning electron microscopy with energy-dispersive spectrometry. The results demonstrated that the TCE reduction capacity of alpha-Fe203 was strongly dependent on the other elements present in iron powder used to synthesize alpha-Fe203. It was suspected that these multi-elements in alpha-Fe203 helped to improve its conduction property. Current findings suggest that alpha-Fe203 not in the pure but combined with other elements could be thought as a potential system for TCE reduction.

Anaerobic treatment of palm oil mill effluent using combined high-rate anaerobic reactors

Combined system of high-rate anaerobic reactors for treating palm oil mill effluent (POME) was developed and investigated in this study. The system composed of one common primary hybrid reactor which was shared by two different secondary filter reactors. An overall COD removal efficiency of 93.5% was achieved in both systems. The secondary reactors contributed not only in enhancing the COD removal efficiency, but also ensured the performance stability of the entire system. Biomass remained intact in the secondary reactor in contrast to the primary reactor in which occasional washout of biomass was observed. The pH of POME was adjusted at the beginning of the operation, as the process continued POME did not require the external pH adjustment as the pH was maintained in desired range. The biogas was produced up to 110 l/d with the yield of 0.171-0.269 l [CH₄]/g [COD removed] and 59.5-78.2% content of methane.

Pseudonormalization of negative T wave during stress test in asymptomatic patients without ischemic heart disease: a clue to apical hypertrophic cardiomyopathy?

INTRODUCTION

Generally, apical hypertrophic cardiomyopathy (ApHCM) shows a negative T wave on an electrocardiogram (ECG), which waxes and wanes during the clinical course. However, some patients with ApHCM just have negative T waves and show no obvious diagnostic evidence on their echocardiography, so the diagnosis of ApHCM cannot be confirmed or is delayed for several years in many cases.

CASE REPORT

In our study, 2 males in their 50s showed negative T waves on their ECG precordial leads, but no diagnosis was confirmed for over 10 years, despite all efforts. Both patients showed pseudonormalization of the negative T wave during a stress test using a treadmill and dobutamine. They were finally diagnosed with ApHCM confirmed by cardiac magnetic resonance (MR).

DISCUSSION

Pseudonormalization of the negative T wave during a stress test is a quite rare phenomenon, particularly in the general population, and cardiac MR is very costly and inaccessible. Thus, when such an ECG pattern is observed without evidence of other pathology, the possibility of ApHCM should be kept in mind and the performance of cardiac MR may be considered. Furthermore, this pseudonormalization pattern could also be one possible explanation for the waxing and waning of the negative T wave during the course of ApHCM.

Properties of synthetic monosulfate as a novel material for arsenic removal

Monosulfate was examined as a novel material for As(V) removal since its layered double hydroxide structure was expected to possess a high capacity for anion exchange. Phase-pure monosulfate was synthesized by hydration at 80-90°C for 36 h using a stoichiometric mixture of tricalcium aluminate (calcined at 1300°C) and gypsum. The analyses of PXRD, WDXRF, and FE-SEM confirmed the successful synthesis of highly pure monosulfate with a negligible impurity of ettringite. Batch experiments were carried out to investigate the kinetics of As(V) removal by monosulfate. A close relationship between As(V) uptake and sulfate release was observed. The intercalation of arsenate in the interlayer of monosulfate was confirmed by PXRD and FT-IR analyses. From a series of equilibrium batch experiments, it is seen that initial sorption of As(V) on monosulfate follows Langmuir isotherm, whereas further injection of As(V) caused transformation of monosulfate to ettringite, which was confirmed by FE-SEM micrographs. However, after the transformation, the solid phases in the equilibrium experiments were found to significantly lose their ability to take up As(V) in exchange for sulfate. A possible explanation for this result was hypothesized and discussed in the context of the literature.

Serial expression of hypoxia inducible factor-1α and neuronal apoptosis in hippocampus of rats with chronic ischemic brain

OBJECTIVE

The purpose of this study is to investigate serial changes of hypoxia-inducible factor 1α (HIF-1α), as a key regulator of hypoxic ischemia, and apoptosis of hippocampus induced by bilateral carotid arteries occlusion (BCAO) in rats.

METHODS

Adult male Wistar rats were subjected to the permanent BCAO. The time points studied were 1, 2, 4, 8, and 12 weeks after occlusions, with n=6 animals subjected to BCAO, and n=2 to sham operation at each time point, and brains were fixed by intracardiac perfusion fixation with 4% neutral-buffered praraformaldehyde for brain section preparation. Immunohistochemistry (IHC), western blot and terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay were performed to evaluate HIF-1α expression and apoptosis.

RESULTS

In IHC and western blot, HIF-1α levels were found to reach the peak at the 2nd week in the hippocampus, while apoptotic neurons, in TUNEL assay, were maximal at the 4th week in the hippocampus, especially in the cornu ammonis 1 (CA1) region. HIF-1α levels and apoptosis were found to fluctuate during the time course.

CONCLUSION

This study showed that BCAO induces acute ischemic responses for about 4 weeks then chronic ischemia in the hippocampus. These in vivo data are the first to show the temporal sequence of apoptosis and HIF-1α expression.

Neuregulin 3 does not confer risk for schizophrenia and smooth pursuit eye movement abnormality in a Korean population

Located on chromosome 10q22-q23, the human neuregulin3 (NRG3) is considered to be a strong positional and functional candidate gene for schizophrenia pathogenesis. Several case-control studies examining the association of polymorphisms in NRG3 with schizophrenia and/or related traits such as delusion have been reported recently in cohorts of Han Chinese, Ashkenazi Jews, Australians and white Americans of Western European ancestry. Thus, this study aimed to comprehensively investigate the association of NRG3 genetic variations with the risk of schizophrenia and smooth pursuit eye movement (SPEM) abnormality in a Korean population. Using TaqMan assay, six single-nucleotide polymorphisms (SNPs) in the intronic region of NRG3 were genotyped and two major haplotypes were identified in 435 patients with schizophrenia as cases and 393 unrelated healthy individuals as controls. A total of 113 schizophrenia patients underwent an eye tracking task, and degree of SPEM abnormality was measured using the logarithmic values of the signal/noise (Ln S/N) ratio. Differences in frequency distributions were analyzed using logistic and regression models following various modes of genetic inheritance and controlling for age and sex as covariates. Subsequent analysis revealed that the frequency distributions of NRG3 polymorphisms and haplotypes were similar between schizophrenia patients and healthy controls of Korean ethnicity. Furthermore, no significant differences were observed between the genetic variants tested for SPEM abnormality. By elucidating a lack of association in a Korean population, findings from this study may contribute to the understanding of the genetic etiology focusing on the role of NRG3 in schizophrenia pathogenesis.

Duodenal somatostatinoma: a case report and review

Somatostatinomas are rare functioning carcinoid tumors that usually arise in the pancreas and duodenum. They are seldom associated with typical clinical symptoms; their diagnosis is confirmed only by histological and immunohistochemical studies and the presence of specific hormones. Two distinct clinicopathological forms of somatostatinoma exist: duodenal and pancreatic somatostatinomas. Clinically, compared to pancreatic somatostatinomas, duodenal somatostatinomas are more often associated with nonspecific symptoms and neurofibromatosis, but less often with somatostatinoma syndrome or metastasis. Histologically, duodenal somatostatinomas frequently have psammoma bodies in the tumor cells. We report a case of duodenal somatostatinoma in 58-year-old man with vague epigastric pain and nausea. He did not have diabetes, steatorrhea, or cholelithiasis. Abdominal computed tomography showed a 25-mm mass in the duodenum and 25-mm nodule in the liver. Endoscopic retrograde cholangiopancreatography showed a duodenal submucosal tumor. Although the endoscopic biopsies were free of malignancy, the patient subsequently underwent Whipple's operation for the duodenal mass. Examination revealed as a somatostatinoma using a special stain for somatostatin.

Stenting of the Left Main Coronary Artery in a Patient With Takayasu's Arteritis

Management of Takayasu's arteritis of the left main coronary artery (LMCA) is difficult because of the possibility of restenosis. Clinically significant stenotic lesions must be considered anatomical correlation. Many studies have reported that the management of stenotic lesions of the LMCA with endoluminal stenting and balloon angioplasty and de-novo stenting is safe and effective for patients with Takayasu's arteritis. We report the case of a patient with Takayasu's arteritis of the LMCA. The patient had undergone two consecutive percutaneous coronary interventions because of recurrent restenosis of in-stent lesions, and eventually underwent coronary artery bypass graft (CABG) surgery for myocardial infarction in the same lesion. We suggested treatment with CABG because the pathophysiology of Takayasu's arteritis is different from that of atherosclerotic stenosis.

Significance of incidental focal uptake in prostate on 18-fluoro-2-deoxyglucose positron emission tomography CT images

To evaluate the clinical significance of incidental focal prostate fluorodeoxyglucose (FDG) uptake, we reviewed 18-F-FDG positron emission tomography (PET)/CT scans from 2003 to 2007 and selected cases with focal FDG uptake in prostate. Cases of known prostate cancer were excluded. The maximum standardised uptake value (SUV(max)), site (central or peripheral) and pattern (discrete or ill-defined) of FDG uptake, calcification (present or absent) and prostate volume (<30 or ≥30 cc) were recorded. The PET/CT findings were correlated with serum prostate-specific antigen (PSA) levels, imaging studies, clinical follow-up and biopsy. Of a total of 5119 cases, 63 (1.2%) demonstrated focal FDG uptake in prostate. Eight cases were lost to follow-up. Among the 55 cases with follow-up, malignancy was confirmed by biopsy in 3 (5.4%). The three malignant cases had SUV(max) values of 3.3, 3.6 and 2.3, and all were noted in the peripheral portion of prostate; two of these cases had a discrete FDG uptake pattern, none had calcification corresponding to the FDG uptake area and one had a prostatic volume greater than 30 cc. The mean SUV(max) of 52 benign cases was 3.2 ± 1.7 and focal FDG uptake was noted in the peripheral portion in 34 (65%), 20 (38%) cases showed a discrete FDG uptake pattern, 35 (67%) were accompanied by calcification and 32 (62%) had a prostatic volume greater than 30 cc. The majority of cases demonstrating focal FDG uptake in prostate were benign and no PET/CT finding could reliably differentiate benign from malignant lesions; however, when discrete focal FDG uptake without coincidental calcification is seen, particularly in the peripheral zone of the prostate, further clinical evaluation is recommended.

The value of dual-time-point 18F-FDG PET/CT for identifying axillary lymph node metastasis in breast cancer patients

OBJECTIVE

The sensitivity of 18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) for detecting axillary lymph node (ALN) metastases in breast cancer is reported to be low. Several studies have shown, however, that dual-time-point (18)F-FDG PET imaging provides improved accuracy in the diagnosis of certain primary tumours when compared with single-scan imaging. The purpose of this study was to assess whether the use of dual-time-point (18)F-FDG PET/CT scans could improve the diagnostic accuracy of ALN metastasis in breast cancer.

METHOD

The study included 171 breast cancer patients who underwent pre-operative (18)F-FDG PET/CT scans at 2 time-points, the first at 1 h after radiotracer injection and the second 3 h after injection. Where (18)F-FDG uptake was in the ALN perceptibly increased, the maximum standardised uptake values for both time-points (SUVmax1 and SUVmax2) and the retention index (RI) were calculated. Correlation between the PET/CT results and post-operative histological results was assessed.

RESULTS

The performance of 1 h and 3 h PET/CT scans was equal, with sensitivity 60.3% and specificity 84.7%, in detecting ALN metastasis. Out of 171 patients, 60 had ALNs with increased (18)F-FDG uptake on 1 h or 3 h images. There was no significant difference in RI between the metastatic ALN-positive group and the node-negative group. The area under the receiver operating characteristic (ROC) curve for SUVmax1 was 0.90 (p<0.001) and 0.87 for SUVmax2 (p<0.001).

CONCLUSION

Dual time-point imaging did not improve the overall performance of (18)F-FDG PET/CT in detecting ALN metastasis in breast cancer patients.

A low sintering temperature and electrical performance of nanoparticle copper ink for use in ink-jet printing

Copper nanoparticles were successfully synthesized from copper chloride with various capping agents. The formation of copper nanoparticles was controlled by varying the species and concentration of the capping agents. The Cu nanoparticles were easily re-dispersed into n-tetradecane, and Cu films were prepared by solution deposition. The thin Cu films form a highly conducting film at low temperature via sintering due to the high surface area to volume ratio. The films were thermally treated at a range of temperatures and then their morphology and resistivity were analyzed. When the Cu films were sintered at 200 degrees C, their electrical resistivity was about 40 microomega. cm.

The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism

BACKGROUND/AIMS

Many prognostic models have been developed to help physicians make medical decisions on treating patients with pulmonary embolism. Among these models, the Pulmonary Embolism Severity Index (PESI) has been shown to be a successful risk stratification tool for patients with acute pulmonary embolism. The PESI, however, had not been applied to patients with pulmonary embolism in Korea.

METHODS

The patients included in this study were diagnosed by computed tomography at Inje University's Ilsan Paik Hospital between December 1999 and March 2007. Risk stratification for the patients was performed using the PESI. The mortality rate was calculated according to each PESI risk class.

RESULTS

Of the 90 patients enrolled in this study, ten were assigned to PESI class I, 29 to PESI class II, 22 to PESI class III, eight to PESI class IV, and ten to PESI class V. The mortality rate after 30 days in each class was 0, 10.3, 9.1, 0, and 50% (p=0.0016), respectively, whereas the respective hospital mortality rate was 4.8, 13.8, 13.6, 12.5, and 50% (p=0.0065). The overall mortality was 9.5, 27.6, 31.8, 50.0, and 60%, respectively (p=0.0019). The mortality rate was significantly associated with the PESI class.

CONCLUSIONS

The PESI class was found to be significantly correlated with the 30-day mortality rate, hospital mortality, and overall mortality. Our data indicate that the PESI can be used to predict the prognosis of patients with pulmonary embolism and in making medical decisions regarding the treatment of patients with pulmonary embolism.

Lymph node dissection around the splenic artery and hilum in advanced middle third gastric carcinoma

AIM

To evaluate the clinicopathological factors influencing lymph node metastasis around the splenic artery and hilum and the effect of spleen-preserved lymphadenectomy in advanced middle third gastric carcinoma.

METHODS

We retrospectively studied 131 patients with advanced middle third gastric carcinoma who had received D2 lymphadenectomy and lymph node dissection around the splenic artery and hilum, from 2000 to 2004. Of these patients, 62 simultaneously underwent splenectomy and 69 underwent spleen-preserved lymphadenectomy.

RESULTS

The incidences of Nos. 10 and 11 lymph node metastases were 21% and 15%, respectively, in advanced middle third gastric carcinoma. A tumor size larger than 5 cm, metastases of Nos. 1 and 7-9 lymph node were independent risk factors for metastasis of No. 10 and/or No. 11 lymph node. The spleen-preserved group had a slightly better survival rate and a relatively lower rate of postoperative complications than the splenectomy group. No. 10 and/or No. 11 lymph node metastasis was an independent prognostic factor, while splenectomy was not.

CONCLUSIONS

It is necessary to remove the lymph nodes around the splenic artery and hilum to achieve radical resection in advanced middle third gastric carcinoma patients with risk factors. Our results demonstrate that spleen-preserved lymphadenectomy is a good option for those patients.

Toxicity of repeated intravenous injection of gene therapeutics for X-CGD in mice

We made gene therapeutics for X-chronic granulomatous disease (CGD) by transducing murine bone marrow-derived stem cells with MT-gp91 retrovirus and evaluated possible toxicity in mice as a prerequisite for human clinical trials. Male C57BL/6 mice were injected intravenously with gene therapeutics for X-CGD twice at an interval of two weeks at 5 × 107 cells/kg and sacrificed 2 weeks after the last administration. Significant changes noted in gene therapeutics for X-CGD-treated animals were an increase in white blood cell counts and a slight decrease in albumin/globulin ratio. The red pulp hyperplasia in the spleen accompanied with an increase in organ weight was considered to result from the accumulation of gene therapeutics for X-CGD, bone marrow-derived stem cells, in the spleen. No anti-gp91 antibody was detected in the sera collected from the animals treated with gene therapeutics for X-CGD. No integration of gp91 DNA from retroviral vector was detected in chromosomal DNA of gonads in animals dosed with the test substance, indicating no potential of genomic integration. In conclusion, the repeated dose of gene therapeutics for X-CGD exerted no toxicity. The splenic red pulp hyperplasia and the increase observed in white blood cell counts and in spleen weights were considered as pharmacological changes induced by the treatment.

Cement paste column for simultaneous removal of fluoride, phosphate, and nitrate in acidic wastewater

Cement paste, a cured mixture of cement and water, was reported to have considerable capacity for fluoride removal. In this study, heavily mixed fluoric acid wastewater from a semiconductor fabrication plant was applied to a column packed with cement paste granules to evaluate its capacity for the removal of fluoride and three other contaminants, phosphate, nitrate, and sulfate, as well as to investigate the interactions between these contaminants and cement components. The column reduced fluoride to remarkably low levels since fluorite was formed at highly elevated concentrations of calcium and the residual fluoride was further sorbed into the amorphous calcium phosphate that precipitated the entire amount of phosphate until breakthrough. The simultaneous removal of sulfate in the earlier stage was followed by significant removal of nitrate in exchange with the gradual release of sulfate. This behavior was explained by the co-precipitation of sulfate with calcium phosphate or calcium aluminate solids and the subsequent substitution of nitrate for the interlayer sulfate of monosulfate. However, the overall removal capacity of cement paste was reduced due to the high effluent loss of calcium and competition for calcium between fluoride and phosphate.

Visceral adipose tissue as a predictor for metabolic risk factors in the Korean population

AIMS

Visceral adipose tissue (VAT) accumulation is closely associated with an increased risk of cardiovascular disease. We have investigated the appropriate VAT cut-off values for predicting metabolic risk factors in the Korean population.

METHODS

We assessed 276 men and 540 women aged 17-69 years who were undergoing regular health examinations. Anthropometry, metabolic risk factors and VAT area determined by computed tomography were measured. Receiver-operating characteristic (ROC) analysis was used to define VAT cut-off points for metabolic risk factors.

RESULTS

Based on the first quintile of VAT, the odds ratios for having metabolic risk factors increased significantly with each VAT quintile in both men and women. Using ROC analysis, the appropriate VAT cut-offs for metabolic risk factors were 100 cm(2) in men and 70 cm(2) in women. Regression lines indicated that, in men, a VAT of 100 cm(2) corresponded to a waist circumference of 88.1 cm and a body mass index (BMI) of 24.9 kg/m(2); in women, a VAT of 70 cm(2) corresponded to a waist circumference of 84.0 cm and a BMI of 25.1 kg/m(2).

CONCLUSION

VAT cut-offs of 100 cm(2) in men and 70 cm(2) in women are useful for defining visceral obesity in Korean subjects. These VAT cut-offs were validated by the ethnic-specific cut-offs for waist circumference and BMI for Korean individuals.

Cdc42 contributes to phorbol ester-induced Ca2+-independent contraction of pulmonary artery smooth muscle

We determined the contribution of the Rho family of low molecular GTP-binding proteins to phorbol ester-induced contraction in swine pulmonary artery smooth muscle. In Ca2+-free medium containing 1 mM EGTA, 12-deoxyphorbol 13-isobutyrate (DPB, 1 microM), a protein kinase C (PKC) activator, elicited sustained contractions, which were not inhibited by treatment with verapamil, a voltage-dependent Ca2+ channel antagonist, and Y27632, a Rho-associated kinase inhibitor. Immunoblot analysis showed three PKC isoforms (alpha, epsilon, and zeta) and two Rho GTPases (RhoA and Cdc42) in both cytosolic and the membrane fractions from quiescent strips. DPB (1 microM) significantly induced PKCalpha and epsilon to translocate from the cytosolic to the membrane fraction in Ca2+-free medium. DPB also elicited the translocation of Cdc42, but not RhoA to the membrane fraction. Similarly, in the experiment for measurement of Rho GTPase activity by pull-down assay, DPB (1 microM) significantly increased the activity of Cdc42 in Ca2+-free medium. Norepinephrine (NE, 10 microM) stimulated the redistribution of RhoA from the cytosolic to the membrane fraction in swine pulmonary artery smooth muscle. In contrast, NE did not alter the subcellular distributions of Cdc42 and the PKC isoforms. These results indicate that phorbol ester evokes PKC-mediated Ca2+-independent contraction via a Rho GTPase pathway, especially Cdc42, in smooth muscle from swine pulmonary arteries.

Mitogen-activated protein kinase contributes to elevated basal tone in aortic smooth muscle from hypertensive rats

The role of mitogen-activated protein kinase (MAPK) in increased basal tone -spontaneous resistance in vascular muscle strips- was clarified in aortic smooth muscle from deoxycorticosterone acetate (DOCA)-salt hypertensive rats. The MAPK/extracellular signal-regulated protein kinase (ERK) kinase inhibitor, PD098059 (2'-amino-3'-methoxyflavone), significantly inhibited basal tone in a dose-dependent manner. The basal level of ERK1/2 activation was inhibited by PD098059 and was significantly greater in hypertensive rats than in sham-operated rats. In contrast, inhibition with PD098059 was not observed in sham-operated rats. GF109203X (2-[1-(3-dimethylaminopropyl)-1H-indol-3-yl]-3-(1H-indol-3-yl)maleimide), an inhibitor of protein kinase C (PKC), decreased both basal tone and ERK1/2 activity in the hypertensive rats. In contrast, Y27632 ((R)-(+)-trans-N-(4-Pyridyl)-4-(1-aminoethyl)cyclohexanecarboxamide) and verapamil, inhibitors of Rho kinase and voltage-dependent Ca2+ channels, respectively, significantly inhibited basal tone but not ERK1/2 activity. Thus, basal vascular tone is elevated by the altered activation of MAPK in DOCA-salt hypertensive rats, and this is regulated by PKC, but not by Rho or intracellular Ca2+.

Primary clear cell sarcoma of bone

Clear cell sarcoma is a rare soft tissue sarcoma of young adults with melanocytic differentiation. It occurs predominantly in the soft tissue of extremities, typically involving tendons and aponeuroses. Primary clear cell sarcoma of bone is extremely rare. We report a case of primary clear cell sarcoma of the right first metatarsal in a 48-year-old woman and provide a literature review of the entity.

Phagocytosis of serum- and IgG-opsonized zymosan particles induces apoptosis through superoxide but not nitric oxide in macrophage J774A.1

Phagocytosis of serum- and IgG-opsonized zymosan (SOZ and IOZ, respectively) particles into J774A.1 macrophages induced apoptosis of the cells, accompanied by the expression of p21(WAF1), one of cyclin-dependent protein kinase (CDK) inhibitors. Furthermore, phagocytosis of SOZ and IOZ particles into macophages induced superoxide formation. Tat-superoxide dismutase (SOD), which is readily transduced into the cells using Tat-domain, protected the cells from the apoptosis induced by phagocytosis of SOZ and IOZ particles. lipopolysaccharide (LPS) /interferon-gamma (IFN-gamma) also caused the apoptosis of the cells. However, Tat-SOD could not protect the cells from LPS/IFN-gamma induced apoptosis, suggesting that apoptosis mechanisms involved are different from each other. In the present study, we determined the amounts of nitric oxide (NO) produced by SOZ, IOZ, and LPS/IFN-gamma, and found that SOZ and IOZ did not induce the generation of NO in macrophages, whereas LPS/ IFN-gamma did. The apoptosis due to phagocytosis was accompanied with the release of cytochrome c from mitochondrial membrane to cytosolic fraction. Furthermore, SOZ and IOZ induced the cleavage of procasapase-3 (35 kDa) to give rise to an active caspase-3 (20 kDa), which was blocked by Tat- SOD but not by 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (PTIO), a scavenger of NO. On the other hand, LPS/IFN-gamma caused the activation of procaspase-3, which was blocked by PTIO but not by Tat-SOD. Taken together, phagocytosis of SOZ and IOZ particles induced apoptosis through superoxide but not NO in macrophages, accompanied with the release of cytochrome c and the activation of caspase-3.

Phosphorylation of 46-kDa protein of synaptic vesicle membranes is stimulated by GTP and Ca2+/calmodulin

The release of neurotransmitter is regulated in the processes of membrane docking and membrane fusion between synaptic vesicles and presynaptic plasma membranes. Synaptic vesicles contain a diverse set of proteins that participate in these processes. Small GTP-binding proteins exist in the synaptic vesicles and are suggested to play roles for the regulation of neurotransmitter release. We have examined a possible role of GTP-binding proteins in the regulation of protein phosphorylation in the synaptic vesicles. GTPgammaS stimulated the phosphorylation of 46 kDa protein (p46) with pI value of 5.0-5.2, but GDPbetaS did not. The p46 was identified as protein interacting with C-kinase 1 (PICK-1) by MALDI-TOF mass spectroscopy analysis, and anti-PICK-1 antibody recognized the p46 spot on 2-dimensional gel electrophoresis. Rab guanine nucleotide dissociation inhibitor (RabGDI), which dissociates Rab proteins from SVs, did not affect phosphorylation of p46. Ca(2+)/calmodulin (CaM), which causes the small GTP-binding proteins like Rab3A and RalA to dissociate from the membranes and stimulates CaM-dependent protein kinase(s) and phosphatase, strongly stimulate the phosphorylation of p46 in the presence of cyclosporin A and cyclophylin. However, RhoGDI, which dissociates Rho proteins from membranes, reduced the phosphorylation of p46 to the extent of about 50%. These results support that p46 was PICK-1, and its phosphorylation was stimulated by GTP and Ca(2+)/CaM directly or indirectly through GTP-binding protein(s) and Ca(2+)/CaM effector protein(s). The phosphorylation of p46 (PICK-1) by GTP and Ca(2+)/CaM may be important for the regulation of transporters and neurosecretion.

Validity of PSA, free/total PSA ratio and complexed/total PSA ratio measurements in men with acute urinary retention

The reliability of serum prostate specific antigen (PSA) measurements in men with acute urinary retention is unclear. Total PSA, free and complexed PSA were measured, and the free/total (f/t) PSA and complexed/total (c/t) PSA ratios calculated, prior to catheterisation and at 48 and 72 h post-catheterisation in 39 men with acute retention. Subsequent histology showed 12 patients had prostate cancer and 27 benign prostatic hypertrophy. Serum free and total PSA fell following catheterisation, while complexed PSA rose during the first 48 h then subsequently fell. The f/t PSA and c/t PSA ratios provided the best discrimination at 48-72 h with 100% sensitivity and 75-82% specificity.Prostate Cancer and Prostatic Diseases (2001) 4, 167-172.

Intraocular pressure measurement at the choroid surface: a feasibility study with implications for implantable microsystems

AIMS

To demonstrate that a sensor, which is inserted through the sclera and placed in intimate contact with the choroid, can reliably detect changes in the intraocular pressure (IOP).

METHODS

A manometer was used to control the IOP of three cadaver eyes in steps of 7 mm Hg. A piezoresistive pressure sensor was used to measure the pressure at the choroid through a 2.5 mm diameter hole that was surgically removed from the sclera. Data were collected for two configurations; with the sensor: (i) rigidly attached to a miniature positioning stage, and (ii) sutured to the sclera.

RESULTS

Both configurations accurately tracked the manometer pressure from 10 mm Hg to 47 mm Hg. For the fixed sensor cases, the average difference between the pressure measured at the choroid and in the anterior chamber was 0.8 mm Hg for the three eyes. For the sutured sensor case, the average difference was 2.1 mm Hg-although a significant portion of this was attributed to an initial offset. The standard deviations at each pressure level for all of the choroid measurements were under 1.0 mm Hg.

CONCLUSIONS

Small changes in IOP can be accurately measured by a sensor in contact with the surface of the choroid, for both a fixed sensor configuration and for a sensor sutured to the sclera. These results are the first step in the realisation of a surgically implantable microsensor to monitor IOP for patients suffering from low tension and other difficult to manage forms of glaucoma.

Fibrosarcoma in bizarre parosteal osteochondromatous proliferation

Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign lesion predominantly involving the small bones of the hands and feet. Malignant transformation in BPOP has not been documented in the English literature. This report presents the coexistence of fibrosarcoma with BPOP in the right distal fibula of an 18-year-old woman.

Clinicopathologic and genotypic study of extranodal nasal-type natural killer/T-cell lymphoma and natural killer precursor lymphoma among Koreans

BACKGROUND

This study aimed to define genotypic profile and to describe the clinicopathologic features of nasal-type natural killer (NK)/T-cell lymphoma of nasal and extranasal origin and NK precursor lymphoma.

METHODS

NK/T-cell lymphomas from the upper aerodigestive tract (n = 45), skin (n = 2), gastrointestinal tract (n = 3), and soft tissue (n = 2) and NK precursor neoplasms (n = 3) were studied. Immunophenotype was analyzed by immunohistochemistry and flow cytometry. In situ hybridization with EBER 1/2 RNA probes was performed. T-Cell Receptor (TCR)-gamma gene rearrangement was analyzed by seminested polymerase chain reaction with heteroduplex analysis. Overall survival rate was correlated with clinicopathologic parameters and compared by Wilcoxon test.

RESULTS

Clonal TCR-gamma gene rearrangement was detected in 3 of 31 upper aerodigestive and 1 of 2 skin tumors. When immunostained using paraffin embedded tissue, 6 upper aerodigestive lymphomas were negative for CD56 in which 4 cases lacked clonal TCR gene rearrangement. Epstein-Barr virus (EBV) mRNA was detected in 33 upper aerodigestive tumors including 26 of 29 nasal tumors (90%), and 7 of 10 extranasal tumors (70%). There was no histologic, immunophenotypic, or genotypic differences according to the lineage and EBV association in upper aerodigestive lymphomas. Among the patients with upper aerodigestive tumors, overall 1-year survival rate was 41%, and correlated well with the stage (P < 0.05) but not with the size of tumor cells, EBV status, and lineage (P > 0.05). Median survival rate of lymphomas from other sites excluding upper aerodigestive tract was not significantly different from that of upper aerodigestive lymphomas with same stage (P > 0.05). Unlike nasal-type NK/T-cell lymphomas, NK precursor lymphoma involved the bone marrow and lymph nodes at initial presentation or in the course of disease. Tumor cells were positive for TdT in all and myeloid markers in two. TCR gene rearrangement was germ line.

CONCLUSIONS

Most upper aerodigestive nasal-type NK/T-cell lymphomas among Koreans are genotypically of NK derivation and few belong to T lineage. Presence or absence of EBV has no significant correlation with the histologic changes and the lineage of these lymphomas.

Pneumocystis carinii pneumonia associated with a rapid reduction of cortisol level in a patient with ectopic ACTH syndrome treated by octreotide and ketoconazole

A case is herein reported of pneumocystis carinii pneumonia in a 60-year-old female patient with ectopic production of ACTH at a position 2 cm superior to her right clavicle, revealed in an octreotide scan. Her extremely high plasma ACTH and cortisol levels (460 pg/ml and 80 microg/dl, respectively) were markedly decreased with the combined treatment of octreotide (300 microg/d) and ketoconazole (600 mg/d). As her serum cortisol concentration decreased, pneumocystis carinii pneumonia occurred on the third day of treatment. A secondary E. coli infection was superimposed and the patient died of disseminated intravascular coagulation and adult respiratory distress syndrome. This case suggests that primary prophylaxis for pneumocystis carinii infection should be initiated before cortisol lowering therapy, especially when the plasma cortisol concentration is excessively high, and that early adjunctive glucocorticoid therapy can reduce the acute mortality in patients with endogenous Cushing's syndrome and Pneumocystis carinii pneumonia. This case study would also like to point out that plasma ACTH and cortisol levels were decreased effectively by the combination of octreotide and ketoconazole in this instance of ectopic ACTH syndrome.

Molecular scanning of insulin-responsive glucose transporter (GLUT4) gene in NIDDM subjects

We investigated the prevalence of mutations in the gene encoding the major insulin-responsive facilitative glucose transporter (GLUT4) in patients with non-insulin-dependent diabetes mellitus (NIDDM). All 11 exons of the GLUT4 gene from 30 British white subjects with NIDDM were amplified using the polymerase chain reaction and screened for nucleotide sequence variation using the single-stranded conformation polymorphism (SSCP) method. No variation between the study subjects was detected in exons 1-3, 4b-8, and 10. Variant SSCP patterns were detected in exons 4a and 9. SSCP variation in exon 4a was revealed by direct nucleotide sequencing to be due to a common silent polymorphism (AAC----AAT at Asn130). One NIDDM patient demonstrated a variant SSCP pattern in exon 9. This was caused by a point mutation (GTC----ATC) at codon 383, which leads to the conservative substitution of isoleucine for valine in the putative fifth extracellular loop of the transporter. Allele-specific oligonucleotide hybridization was used to examine the frequency of this mutation in 240 Welsh white subjects (160 with NIDDM and 80 controls). The Val----Ile383 mutation was found in the heterozygous state in two diabetic subjects and no control subjects. We conclude that mutations of the GLUT4 coding sequence are very uncommon in this population of subjects with typical NIDDM. Determining whether the Ile383 GLUT4 variant present in 3 diabetic subjects contributes in any way to their disease will require further study.