Potential impact of high-density lipoprotein cholesterol in the postoperative outcomes of chronic subdural hematoma patients: multi-institutional study in Korea

BACKGROUND

Chronic subdural hematoma (CSDH) is a common clinical situation in neurosurgical practice, but the optimal treatment option is controversial. This study aimed to evaluate the effect of cholesterol-lowering medications on and how they affected the prognoses of CSDH patients.

METHODS

In this multi-institutional observational study performed in Korea, data from recently treated CSDH patients were gathered from 5 hospitals. A total of 462 patients were collected from March 2010 to June 2021. Patient clinical characteristics, history of underlying diseases and their treatments, radiologic features, and surgical outcomes were analyzed.

RESULTS

Seventy-five patients experienced recurrences, and 62 had reoperations after the initial burr hole surgery. Among these, 15 patients with recurrences and 12 with reoperations were taking cholesterol-lowering medications. However, the use of medications did not significantly affect recurrence or reoperation rates (P = 0.350, P = 0.336, respectively). When analyzed by type of medication, no clinically relevant differences in total cholesterol (TC), triglyceride (TG), or low-density lipoprotein cholesterol (LDL-C) levels were identified. The combination of a statin drug and ezetimibe significantly elevated high-density lipoprotein cholesterol (HDL-C) levels (P = 0.004). TC, LDL-C, and TG levels did not significantly affect patient prognoses. However, HDL-C levels and recurrence (odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.94-0.99; p = 0.010) were negatively correlated. An HDL-C level of 42.50 mg/dL was identified as the threshold for recurrence and reoperation.

CONCLUSIONS

In this study, using cholesterol-lowering medications did not significantly impact the prognosis of patients who underwent surgical management for a chronic subdural hematoma. However, the findings showed that the higher the HDL-C level, the lower the probability of recurrence and reoperation.

Balancing Bleeding Risk and Thromboembolic Complications in Elderly Chronic Subdural Hematoma Patients Undergoing Burr Hole Trephination : A Multicenter Retrospective Cohort Study and Literature Review

OBJECTIVE

Chronic subdural hematoma (CSDH) patients using antithrombotic agents (AT) at high risk for cardiovascular disease are increasing. The authors aimed to analyze the factors influencing outcome by targeting patients using AT and to establish a desirable treatment strategy.

METHODS

A retrospective analysis was performed on data from 462 patients who underwent burr hole trephination (BHT) surgery for CSDH at five hospitals from March 2010 to June 2021. Outcomes included incidence of postoperative acute bleeding, recurrence rate, and morbidity or mortality rate. Patients were divided into the following four groups based on their history of AT use : no AT. Only antiplatelet agents (AP), only anticoagulants (AC), both of AP and AC. In addition, a concurrent literature review was conducted alongside our cohort study.

RESULTS

Of 462 patients, 119 (119/462, 25.76%) were using AT. AP prescription did not significantly delay surgery (p=0.318), but AC prescription led to a significant increase in the time interval from admission to operation (p=0.048). After BHT, AP or AC intake significantly increased the period required for an in-dwelling drain (p=0.026 and p=0.037). The use of AC was significantly related to acute bleeding (p=0.044), while the use of AP was not (p=0.808). Use of AP or AC had no significant effect on CSDH recurrence (p=0.517 and p=1.000) or reoperation (p=0.924 and p=1.000). Morbidity was not statistically correlated with use of either AP or AC (p=0.795 and p=0.557, respectively), and there was no significant correlation with mortality for use of these medications (p=0.470 and p=1.000).

CONCLUSION

Elderly CSDH patients may benefit from maintenance of AT therapy during BHT due to reduced thromboembolic risk. However, the use of AC necessitates individualized due to potential postoperative bleeding. Careful post-operative monitoring could mitigate prognosis and recurrence impacts.

DPSC-Derived Extracellular Vesicles Promote Rat Jawbone Regeneration

Repair and functional reconstruction of large jawbone defects remain one of the challenges in the field of head and neck surgery. The recent progress in tissue engineering technologies and stem cell biology has significantly promoted the development of regenerative reconstruction of jawbone defects. The multiple trophic activities of extracellular vesicles (EVs) produced by mesenchymal stem cells (MSCs) may play a critical role in their therapeutic effects. Accumulating evidence has shown the promise of dental pulp stem cells (DPSCs) in bone regeneration, but less is known about the regenerative effects of DPSC-EVs on jawbone defects. The purpose of this study is to explore the osteogenic effects of DPSC-EVs on jawbone marrow-derived MSCs (JB-MSCs) in vitro and their osteoinductive effects in a mandibular bone defect model in rats. Our results showed that JB-MSCs could efficiently uptake DPSC-EVs, which in turn significantly promoted the expression of osteogenic genes, such as runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), and osteocalcin (OCN), as well as the osteogenic differentiation capability of JB-MSCs. Meanwhile, we found that the pro-osteogenic effect in vitro induced by DPSC-EVs was comparable to that induced by BMP-2 (bone morphogenetic protein 2), currently the only Food and Drug Administration-approved osteoinductive growth factor. In vivo, animals that were locally treated with DPSC-EVs laden with a commercially available collagen membrane exhibited a relatively fast wound closure and increased new bone density at the mandible defects. Our results provide evidence for the osteogenic and osteoinductive effects of DPSC-EVs on jawbone regeneration. Due to the accessibility, rapid proliferation, and osteogenic propensity of DPSCs, DPSC-EVs may represent a safe cell-free therapeutic approach for craniofacial bone regeneration.

Increase in Trigeminal Nerve Cross-Sectional Area on Immediate Postoperative MRI Predicts Favorable Outcome After Microvascular Decompression for Classical Trigeminal Neuralgia

BACKGROUND

Although distortion or indentation of a trigeminal nerve due to neurovascular compression (NVC) is associated with classical trigeminal neuralgia, whether morphological change in the trigeminal nerve is relieved by eliminating NVC has not been studied.

OBJECTIVE

To estimate morphological change in the trigeminal nerve after microvascular decompression (MVD).

METHODS

Fifty patients with classical trigeminal neuralgia who underwent MVD were included. Using coronal images in both preoperative and postoperative MRI, the trigeminal nerve cross-sectional area (CSA) was measured at 4 mm anterior to the nerve entry into the pons. Clinical outcomes were assessed using the Barrow Neurological Institute Pain Intensity Scale (BNI-PS) at the patient's latest follow-up.

RESULTS

Forty-one patients achieved favorable outcomes without medication (BNI-PS I or II), and 9 patients had residual pain (BNI-PS ≥ 3A). The mean symptomatic trigeminal nerve CSA was increased by 51.47% after MVD in the favorable outcome group (preoperative: 4.37 ± 1.64 mm 2 vs postoperative: 6.26 ± 1.76 mm 2 , P < .01), whereas it was not significantly changed in the unfavorable outcome group (preoperative: 4.20 ± 1.19 mm 2 vs postoperative: 4.43 ± 1.24 mm 2 , P = .69). Kaplan-Meier survival analysis showed that the 3-year probability of maintaining a favorable outcome was 92.3 ± 7.4% and 56.1 ± 11.9%, for those whose symptomatic trigeminal nerve CSA was increased by over 20% and less than 20%, respectively ( P < .01).

CONCLUSION

Morphological changes in the trigeminal nerve due to NVC could be recovered by MVD, and increases in the trigeminal nerve CSA predicted favorable outcomes.

Serum ammonia as an early predictor of in-hospital mortality in patients with glufosinate poisoning

Background:

The mortality rate associated with human glufosinate poisoning is high. We evaluated the usefulness of serum ammonia and sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) scores for early prediction of in-hospital mortality in glufosinate ammonium poisoning.

Methods:

A prospectively collected pesticide poisoning registry at a single academic medical center was retrospectively analyzed. Data were collected from consecutive patients diagnosed with glufosinate ammonium poisoning between May 2007 and February 2018. The initial serum ammonia level was defined as the highest serum ammonia level measured within 12 h after emergency department (ED) arrival. The SOFA and APACHE II scores were calculated using data obtained within the first 12 h after ED arrival. The patients were divided into survivor and nonsurvivor groups by in-hospital death status.

Results:

In total, 110 patients were included. Ten patients (9.1%) died in the hospital despite treatment. Median initial serum ammonia level was significantly higher in the nonsurvivor group than in the survivor group (219 (range: 158–792) versus 100.5 (range: 25–317) µg/dL, p < 0.001). Median SOFA and APACHE II scores in the survivor and nonsurvivor groups were 2 (range: 0–10) versus 5 (range: 1–8) ( p = 0.044) and 7 (range: 0–28) versus 16 (range: 8–22) ( p = 0.001), respectively. In the multiple logistic regression analysis, the initial serum ammonia level was the only independent predictor (cutoff value: 151 µg/dL).

Conclusion:

An initial serum ammonia level >151 µg/dL was an independent early predictor of in-hospital mortality in glufosinate ammonium poisoning.

Hemifacial Spasm Caused by a Vein: A Case Report

Hemifacial spasm (HFS) caused by a venous offender is rare, and its clinical course and optimal surgical strategy are unclear. A case of 57-year-old male who had an HFS caused by a venous offender is described in this report. Frontalis, orbicularis oculi, orbicularis oris, and mentalis muscles were involved while his platysma muscle showed no spasm. He was treated successfully with microvascular decompression using Teflon felt and 12 months outcome was excellent without any complications. Lateral spread response was not observed in the facial electromyography during the whole operation. Adequate visualization of the facial nerve root exit zone and meticulous exploration for offenders are necessary to avoid surgical failure and reoperation.

Hemifacial Trigeminal Pain Referred from Occipital Neuralgia Due to Compression of the Greater Occipital Nerve by the Occipital Artery

Although pathologic vascular contact between the occipital artery and the greater occipital nerve (GON) at the crossing point in the nuchal subcutaneous layer can cause occipital neuralgia, referred hemifacial trigeminal pain from chronic occipital neuralgia owing to this cause is extremely rare.A 61-year-old female patient with left-sided occipital neuralgia for 4 years presented with a new onset of left-sided hemifacial pain. Decompression of the left GON from pathologic contacts with the occipital artery resulted in immediate relief for hemifacial pain and chronic occipital neuralgia. The present case implies that sensitization and hyperactivity of the trigeminocervical complex that receives the convergent input from trigeminal and high cervical occipital nociceptive pathways can be a pathogenic mechanism in referred hemifacial pain from occipital neuralgia. In the present case, a branching tributary of the occipital artery at the crossing point forming a constricting loop above the course of the GON was found to be the cause of entrapment. Because the occipital artery is reported to be consistently located superficial to the GON at the crossing point, a spatial relationship between the occipital artery and the GON rather than a mere adhesion or contact might have pathologic significance in the development of occipital neuralgia.

Technical Implications in Revision Surgery for Deep Brain Stimulation (DBS) of the Thalamus for Refractory Epilepsy

Background and Purpose

Implantation of deep brain stimulation (DBS) electrodes in the anterior nucleus of the thalamus (ANT) or the centromedian nucleus (CM), for the treatment of refractory epilepsy, is technically demanding. To enhance the accuracy of electrode placement within the ANT and CM, we analyzed our experience with electrode revision surgery in ANT and CM DBS and investigated the cause of misplacement and verifying methods for accurate placement.

Methods

A retrospective analysis of the medical records of 23 patients who underwent DBS for refractory epilepsy during the period from 2013 to 2016 was performed.

Results

Misplacement of the electrode occurred in 1 (25%) of 4 ANT DBS and 2 (14.3%) of 14 patients with CM DBS performed in our institute, and revision surgery was performed in three patients. During this period, we performed three revision surgeries for misplaced electrodes in ANT DBS that were performed at another hospital. Therefore, we performed six revision surgeries (four in ANT, two in CM) for mistargeted DBS electrodes for thalamic DBS. Transventricular lead placement and an anatomical targeting of the ANT was the cause of misplacement in the ANT and intraoperative brain shift was found to be the cause in the CM. For verification of the location of lead placement, magnetic resonance imaging (MRI) was superior to computed tomography and electroencephalography (EEG).

Conclusions

To reduce the rate of electrode misplacement for refractory epilepsy, image-based targeting of the ANT according to individual anatomical variation, and efforts to minimize intraoperative brain shift are essential. To verify the location of the electrode, MRI examination is mandatory in DBS for refractory epilepsy.

Occipital Neuralgia from C2 Cavernous Malformation

A unique case is presented of chronic occipital neuralgia (ON) caused by cavernous malformation (CM) in the intramedullary C2 spinal cord and subsequent pain relief and remodeling of allodynic pain following dorsal root rhizotomy. A 53-year-old male presented with a 30-year history of chronic allodynic, paroxysmal lancinating pain in the greater and lesser occipital nerves. Typically, the pain was aggravated with neck extension and head movement. Magnetic resonance imaging showed a CM in the right posterolateral side of the intramedullary C2 cord. Considering potential risks associated with removal of the lesion, intradural C1-3 dorsal root rhizotomy with dentate ligament resection was performed. The paroxysmal lancinating pain of ON was significantly alleviated, and the remodeling of the extent of allodynic pain was noted after C1-3 dorsal root rhizotomy. These changes gradually occurred during the second postoperative month, and this effect was maintained for 24 months postoperatively. Significant reduction in chronic allodynic pain of secondary ON caused by cervicomedullary CM involving central sensitization in the trigeminocervical complex was observed with reduction of irritating, afferent input with C1-C3 dorsal root rhizotomy.

Venous Malformation (Cavernous Hemangioma) of the Supraorbital Nerve

Cavernous hemangiomas are not true vascular tumors, but rather are slow-flow venous malformations (VMs). They are present at birth as nonproliferating vascular birthmarks composed of anomalous ectatic venous channels. VMs have often been incorrectly called cavernous hemangiomas and cavernous angiomas. These terms have for a long time lead to confusion with the more common proliferating or true hemangioma of infancy. VM has been reported to arise at all sites including skin and subcutaneous layers of the head and neck, face, extremities, liver, gastrointestinal tract, and even the thymus. Although VMs are common intraocular tumors and are involved within intracranial, extraaxial cranial nerves within the cavernous sinus has been sporadically reported, and less often in the supraorbital nerve, an extraocular and extracranial division of the trigeminal nerve has not been reported. The authors present an extremely rare occurrence of VM involving the supraorbital nerve in an 80-year-old female.

Cerebrospinal Fluid Egress from the Quadripolar Deep Brain Stimulation Electrode for Anterior Nucleus of the Thalamus for Refractory Epilepsy

Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an effective treatment for refractory epilepsy. Due to the unique location of ANT in the thalamus facing the lateral and third ventricles, transventricular DBS lead placement is an essential part of ANT DBS. However, there is no report regarding hardware problems including impedance variability in transventricular ANT DBS due to limited experience. A 45-year-old male patient with previously effective, bilateral ANT DBS presented with increasing seizure frequency and a shortened battery longevity within 2 years. Magnetic resonance imaging showed that the left-sided DBS lead was in the third ventricle leaning on the medial wall of ANT. Electrode revision was performed. Upon disconnecting the proximal lead from the extension connection, cerebrospinal fluid egress through fine gaps between the metallic electrode contacts, and electrode spacing was observed. This case raises a concern about the transventricular approach for ANT lead placement because the currently available DBS electrode lead is not waterproofed. A careful, longitudinal follow-up of DBS impedance for ANT DBS is warranted.

Twiddler's Syndrome: A Rare Hardware Complication in Spinal Cord Stimulation

Twiddler's syndrome is an uncommon hardware complication involving the lead and pulse generators in cardiac pacemakers and defibrillators, deep brain stimulators, and vagal nerve stimulators. However, until very recently, it had not been reported in spinal cord stimulation (SCS). Considering the incidence of hardware complications of spinal cord stimulation, there may be an underreporting of Twiddler's syndrome due to lack of awareness. Two cases of Twiddler's syndrome as a hardware complication of SCS were identified between 2005 and 2015. One patient with hardware failure due to Twiddler's syndrome refused to have a revision surgery. The other patient who had a lead migration associated with coiling of the lead and twisting of pulse generator needed a revision surgery. Twiddler's syndrome in patients treated with SCS is an uncommon but important adverse event. Awareness of characteristic presentation and radiologic finding is essential in the identification of Twiddler's syndrome in SCS.

Peroneal Nerve Palsy Due to Subparaneurial Ganglion Cyst, a Rare Variant of Intraneural Ganglion Cyst

Intraneural ganglion cysts are rare mucinous cysts originating within the epineurium of peripheral nerves. Although ganglion cysts are the most frequent tumors of the upper and lower extremities, ganglion cysts rarely result in peripheral nerve compression. We report a case of a 30-year-old patient who presented with foot drop due to subparaneurial ganglion cyst, a variant of an intraneural ganglion cyst. Characteristic magnetic resonance imaging findings were essential in the preoperative diagnosis of intraneural ganglion cyst. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation. The articular branches were addressed. The mucious content of the ganglion was typically found to be located within the subparaneurial compartment. Incision of the subparaneurial ganglion cyst was performed, and mucinous content was evacuated. At 2 months after the surgery, paralyzed peroneal nerve was recovered completely. Therefore, early diagnosis of intraneural ganglion, precise identification of the pathology, and proper treatment of the articular branch with atraumatic dissection of ganglion cyst are essential in the successful management of this rare lesion.

Intraoperative Neurophysiological Monitoring (Motor and Somatosensory Evoked Potentials) in Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Pain

AIMS

To address the feasibility and importance of intraoperative neurophysiological monitoring (IONM) in dorsal root entry zone (DREZ) lesioning for brachial plexus avulsion pain.

METHODS

Muscle motor evoked potential (mMEP) and somatosensory evoked potential (SSEP) were applied during DREZ lesioning for brachial plexus avulsion pain.

RESULTS

IONM of mMEPs and SSEPs was feasible for monitoring of the spinal cord during DREZ lesioning. With the exception of 3 unrecordable mMEPs in ipsilateral arms, mMEPs were preserved and referenced to look for changes according to lesioning in 6 upper extremities (66.6%) and 8 lower extremities. All 3 patients with >50% reduction in baseline mMEP amplitude after lesioning in either the ipsilateral upper or lower extremities showed postoperative ataxia and weakness of the lower extremities (100%). Only 2 out of 9 patients (22.2%) with brachial plexus avulsion pain had discernible baseline SSEPs in the ipsilateral upper extremities. One of 2 patients with discernible SSEPs in the upper extremities showed significant SSEP events during the DREZ lesioning and experienced postoperative ataxia and weakness in the legs despite the absence of a SSEP event in the lower extremities.

CONCLUSION

Significant events on IONM were common during DREZ lesioning for brachial plexus avulsion pain and were closely related to the occurrence of postoperative neurological deficits.

Relationship between Postoperative EEG Driving Response and Lead Location in Deep Brain Stimulation of the Anterior Nucleus of the Thalamus for Refractory Epilepsy

OBJECTIVES

Interpreting the postoperative electroencephalographic (EEG) driving response (DR) as an indicator of electrode placement within the thalamic nucleus in deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) for refractory epilepsy is controversial.

MATERIALS AND METHODS

We retrospectively investigated the relationship between postoperative EEG DR and the location of 11 electrodes in 6 patients who underwent ANT DBS for refractory epilepsy.

RESULTS

Cerebral synchronizing EEG DR was observed in 10 electrodes. However, 9 of the 11 electrodes were located within the ANT. For the 2 electrodes that missed the ANT, DR was observed in 1 misplaced electrode facing the anterior surface of the ANT within the third ventricle. The other misplaced electrode without DR elicitation showed a DR after electrode repositioning.

CONCLUSIONS

The diagnostic significance of DR as indirect evidence of electrodes being within thalamic nuclei is limited. If DR is not elicited, it should be regarded as a misplacement. Even if DR is elicited, it may not be interpreted as a sound indicator of proper electrode placement within the thalamus. A sophisticated, postoperative imaging study is warranted in every case of ANT DBS.

Clinical Outcome of Patients with Deep Brain Stimulation of the Centromedian Thalamic Nucleus for Refractory Epilepsy and Location of the Active Contacts

OBJECTIVES

To investigate the clinical outcome of patients treated with chronic deep brain stimulation (DBS) of the centromedian nucleus (CM) for refractory epilepsy and to determine the location of active contacts.

METHODS

The outcome of CM stimulation was evaluated as percent seizure reduction compared to the baseline 3 months. To establish the location of active contacts, 27 leads were studied in 14 patients with refractory epilepsy. An analysis was conducted to reveal whether any coordinates of the center of the active contacts predicted percent seizure reduction.

RESULTS

With an average follow-up of 18.2 ± 5.6 months, the mean percent seizure reduction (n = 14) was 68 ± 22.4% (25-100%). Eleven of the 14 patients (78.6%) achieved >50% improvement in seizure frequency. Specifically, all 4 patients (100%) with generalized epilepsy (Lennox-Gastaut syndrome) and 7 of 10 patients (70%) with multilobar epilepsy showed >50% reduction in seizure frequency. The mean coordinates of the center of the active contact were located in the superior part of the anterior ventrolateral CM. The calculated coordinates of laterality from midline (x), anterior-posterior (y) and height (z) from the posterior commissure did not correlate with seizure outcome measured by percent seizure reduction. However, the locations of active contacts used during chronic CM stimulation in multilobar epilepsy were identified more dorsal to those used in generalized epilepsy.

CONCLUSIONS

Chronic CM stimulation is a safe and effective means in the treatment of refractory epilepsy.

Lentivirus pre-packed with Cas9 protein for safer gene editing

The CRISPR/Cas9 system provides an easy way to edit specific site/s in the genome and thus offers tremendous opportunity for human gene therapy for a wide range of diseases. However, one major concern is off-target effects, particularly with long-term expression of Cas9 nuclease when traditional expression methods such as via plasmid/viral vectors are used. To overcome this limitation, we pre-packaged Cas9 protein (Cas9P LV) in lentiviral particles for transient exposure and showed its effectiveness for gene disruption in cells, including primary T cells expressing specific single guide RNAs (sgRNAs). We then constructed an 'all in one virus' to express sgRNAs in association with pre-packaged Cas9 protein (sgRNA/Cas9P LV). We successfully edited CCR5 in TZM-bl cells by this approach. Using an sgRNA-targeting HIV long terminal repeat, we also were able to disrupt HIV provirus in the J-LAT model of viral latency. Moreover, we also found that pre-packaging Cas9 protein in LV particle reduced off-target editing of chromosome 4:-29134166 locus by CCR5 sgRNA, compared with continued expression from the vector. These results show that sgRNA/Cas9P LV can be used as a safer approach for human gene therapy applications.

Models for Estimating Genetic Parameters of Milk Production Traits Using Random Regression Models in Korean Holstein Cattle

The objectives of the study were to estimate genetic parameters for milk production traits of Holstein cattle using random regression models (RRMs), and to compare the goodness of fit of various RRMs with homogeneous and heterogeneous residual variances. A total of 126,980 test-day milk production records of the first parity Holstein cows between 2007 and 2014 from the Dairy Cattle Improvement Center of National Agricultural Cooperative Federation in South Korea were used. These records included milk yield (MILK), fat yield (FAT), protein yield (PROT), and solids-not-fat yield (SNF). The statistical models included random effects of genetic and permanent environments using Legendre polynomials (LP) of the third to fifth order (L3–L5), fixed effects of herd-test day, year-season at calving, and a fixed regression for the test-day record (third to fifth order). The residual variances in the models were either homogeneous (HOM) or heterogeneous (15 classes, HET15; 60 classes, HET60). A total of nine models (3 orders of polynomials×3 types of residual variance) including L3-HOM, L3-HET15, L3-HET60, L4-HOM, L4-HET15, L4-HET60, L5-HOM, L5-HET15, and L5-HET60 were compared using Akaike information criteria (AIC) and/or Schwarz Bayesian information criteria (BIC) statistics to identify the model(s) of best fit for their respective traits. The lowest BIC value was observed for the models L5-HET15 (MILK; PROT; SNF) and L4-HET15 (FAT), which fit the best. In general, the BIC values of HET15 models for a particular polynomial order was lower than that of the HET60 model in most cases. This implies that the orders of LP and types of residual variances affect the goodness of models. Also, the heterogeneity of residual variances should be considered for the test-day analysis. The heritability estimates of from the best fitted models ranged from 0.08 to 0.15 for MILK, 0.06 to 0.14 for FAT, 0.08 to 0.12 for PROT, and 0.07 to 0.13 for SNF according to days in milk of first lactation. Genetic variances for studied traits tended to decrease during the earlier stages of lactation, which were followed by increases in the middle and decreases further at the end of lactation. With regards to the fitness of the models and the differential genetic parameters across the lactation stages, we could estimate genetic parameters more accurately from RRMs than from lactation models. Therefore, we suggest using RRMs in place of lactation models to make national dairy cattle genetic evaluations for milk production traits in Korea.

Long-Term Migration of a Deep Brain Stimulation (DBS) Lead in the Third Ventricle Caused by Cerebral Atrophy in a Patient with Anterior Thalamic Nucleus DBS

The long-term (5-years) antiepileptic effect of deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) against refractory epilepsy has been reported. However, experience with ANT DBS for epilepsy is limited, and so hardware complications and technical problems related to ANT DBS are unclear. We report the case of a 57-year-old male who underwent re-implantation of a DBS lead in the left ANT because of lead migration into the third ventricle detected 8 years after the first DBS, and which was caused by the significant enlargement of the lateral and third ventricles. After re-implantation, the patient showed a mechanically-related antiepileptic effect and a prominent driving response of the electroencephalography was verified. We speculate that progressive dilatation of the ventricle and shallow, insufficient implantation of the lead during the initial ANT DBS may have caused migration of the DBS lead. Because dilatation of the ventricle could progress years after DBS in a patient with chronic epilepsy, regular follow-up imaging is warranted in ANT DBS patients with an injured, atrophied brain.

A genome-wide analysis of the ultimate pH in swine

Meat pH is an important factor influencing meat quality traits in swine. This study evaluated a large number of genetic variants that covered all of the swine chromosomal regions. Approximately 68,000 single nucleotide polymorphisms (SNPs), found on Illumina Porcine SNP chips, were tested for associations with meat pH values. A genome-wide association study (GWAS) found that 19 SNPs on Sus scrofa chromosome 4 were significantly associated with pH. Two major candidate genomic regions were defined: a 1.08-Mb region (at nucleotide 30118313 to 31207050) contained 10 significant SNPs, based on an effect value of 5.0; and a 2.7-Mb genomic region (at nucleotide 73293076 to 76023681) contained 9 significant SNPs. Three putative genes--PKHD1L1, VCPIP1, and LOC102166532--were identified by GWAS near significant SNPs. These genes may account for variations in pH levels. Three pseudogenes and two non-coding RNAs were also detected by GWAS analysis. Estimations of expected and observed P values for pH revealed significant departures from the null hypothesis. A total of 9 haplotype blocks (HB) were constructed: HBs 1, 3, and 5 showed significant effects on pH24 and pH45, whereas an association was not confirmed between pH24 and HBs 4, 6, and 8. Findings from this study indicate that the three genes identified may influence pH of pig meat.

Estimation of Genetic Associations between Production and Meat Quality Traits in Duroc Pigs

Data collected from 690 purebred Duroc pigs from 2009 to 2012 were used to estimate the heritability, and genetic and phenotypic correlations between production and meat quality traits. Variance components were obtained through the restricted maximum likelihood procedure using Wombat and SAS version 9.0. Animals were raised under the same management in five different breeding farms. The average daily gain, loin muscle area (LMA), backfat thickness (BF), and lean percent (LP) were measured as production traits. Meat quality traits included pH, cooking loss, lightness (L*), redness (a*), yellowness (b*), marbling score (MS), moisture content (MC), water holding capacity (WHC), and shear force. The results showed that the heritability estimates for meat quality traits varied largely from 0.19 to 0.79. Production traits were moderate to highly heritable from 0.41 to 0.73. Genotypically, the BF was positively correlated (p<0.05) with MC (0.786), WHC (0.904), and pH (0.328) but negatively correlated with shear force (−0.533). The results of genetic correlations indicated that selection for less BF could decrease pH, moisture content, and WHC and increase the shear force of meat. Additionally, a significant positive correlation was recorded between average daily gain and WHC, which indicates pork from faster-growing animals has higher WHC. Furthermore, selection for larger LMA and LP could increase MS and lightness color of meat. The meat quality and production traits could be improved simultaneously if desired. Hence, to avoid further deterioration of pork characteristics, appropriate selection of traits should be considered.

Effect of alcohol fermented feed on lactating performance, blood metabolites, milk Fatty Acid profile and cholesterol content in holstein lactating cows

A feeding experiment with 40 lactating Holstein cows and 4 dietary treatments was conducted to investigate supplementation with different levels of alcohol fermented feed to the TMR on lactating performance, blood metabolites, milk fatty acid profile and cholesterol concentration of blood and milk. Forty Holstein lactating cows (106±24 d post-partum; mean±SD) were distributed into four groups and randomly assigned to one of four treatments with each containing 10 cows per treatment. The treatment supplemented with TMR (DM basis) as the control (CON), and CON mixed with alcohol-fermented feeds (AFF) at a level of 5%, 10% and 15% of the TMR as T1, T2 and T3, respectively. Dry matter intake and milk yield were not affected by supplementation of AFF. An increased 4% FCM in the milk occurred in cows fed T3 diet compared with CON, while T1 and T2 diets decreased 4% FCM in a dose dependent manner. Supplementation of AFF increased the concentration of albumin, total protein (TP), ammonia, and high density lipoprotein-cholesterol in serum compared with CON. In contrast, supplementation with AFF clearly decreased concentration of blood urea nitrogen (BUN) and total cholesterol (TC) compare with CON. AFF supplementation increased the proportion of C18:1n9 and C18:2n6 compared to CON. A decrease in the concentration of saturated fatty acid (SFA) for T1, T2 and T3 resulted in an increased unsaturated fatty acid (USFA) to SFA ratio compared to CON. Concentration of cholesterol in milk fat was reduced in proportion to the supplemental level of AFF. Feeding a diet supplemented with a moderate level AFF to lactating cows could be a way to alter the feed efficiency and fatty acid profile of milk by increasing potentially human consumer healthy fatty acid without detrimental effects on feed intake and milk production. A substantially decreased cholesterol proportion in milk induced by supplementation AFF suggests that alcohol fermented feed may improve milk cholesterol levels without any negative effects in lactating cows.

Curcumin decreases oleic acid-induced lipid accumulation via AMPK phosphorylation in hepatocarcinoma cells

BACKGROUND AND OBJECTIVES

Non-alcoholic fatty liver disease (NAFLD) is one of the most common metabolic syndromes and is characterized by the accumulation of hepatic triglycerides (TG), which result from an imbalance between uptake, synthesis, export, and oxidation of fatty acids. Curcumin is a polyphenol derived from the herbal remedy and dietary spice turmeric, was found to prevent obesity and diabetes in mouse models. However, a hypolipidemic effect of curcumin in oleic acid- induced hepatocarcinoma cells has not been reported. In this study, we examined the effect of curcumin on reducing lipid accumulation in hepatic cells.

MATERIALS AND METHODS

Hepatocytes were treated with oleic acid (OA) containing with or without curcumin to observe the lipid accumulation by Oil Red O stain. We also tested the effects of curcumin on triglycerides (TG) and total cholesterol (TC) in HepG2 cells. Western blot and reverse transcription polymerase chain reaction (RT-PCR) was used to measure sterol regulatory element binding proteins-1 (SREBP-1), fatty acid synthase (FAS), peroxisome proliferator-activated receptor (PPAR)-α, and adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) expression.

RESULTS

Curcumin suppressed OA-induced lipid accumulation and TG and TC levels. Also, curcumin decreased hepatic lipogenesis such as SREBP-1, and FAS. Besides, we also found out the antioxidative effect of curcumin by increasing the expression of PPARα. Curcumin increased AMPK phosphorylation in hepatocytes.

CONCLUSIONS

These results indicated that curcumin has the same ability to activate AMPK and then reduce SREBP-1, and FAS expression, finally leading to inhibit hepatic lipogenesis and hepatic antioxidative ability. In this report, we found curcumin exerted a regulatory effect on lipid accumulation by decreasing lipogenesis in hepatocyte. Therefore, curcumin extract may be active in the prevention of fatty liver.

Anti-inflammatory effects of Hylomecon hylomeconoides in RAW 264.7 cells

BACKGROUND AND OBJECTIVES

Papaveraceae serve as a rich source of various alkaloids which have anti-inflammatory effect.

MATERIALS AND METHODS

In this study, we investigated the effect of Hylomecon hylomeconoides ethanol extract (HHE) on lipopolysaccharide (LPS)-induced NO and interleukin-6 (IL-6) production in RAW 264.7 cells.

RESULTS

HHE inhibited LPS-induced NO and IL-6 production. Moreover, HHE suppressed the phosphorylation of ERK1/2 and p38 in LPS-induced RAW 264.7 in a dose-dependent manner. Furthermore, major constituents, dihydrosanguinarine and 6-methoxydihydrosanguinarine, of the chloroform-soluble extract were analyzed.

CONCLUSIONS

Taken together, the results of this study indicate that the anti-inflammatory effects of HHE may occur via the inhibition of NO and IL-6 expression through the down-regulation of MAP kinase (ERK1/2, p38) phosphorylation in RAW 264.7 cells.

Antibacterial activity of bark of Alnus pendula against methicillin-resistant Staphylococcus aureus

BACKGROUND AND OBJECTIVES

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a rapidly growing health problem around the globe. Recently, there has been considerable interest in the use of plant materials as an alternative method to control pathogenic microorganisms. In this study we evaluated the antibacterial activity of bark of Alnus pendula against MRSA.

MATERIALS AND METHODS

The MIC determination was done using the microdilution broth method and bacterial growth was determined by measuring optical density using spectrophotometer.

RESULTS

Alnus pendula bark EtOH extract and fractions (F-1, -2, -3 and -4) were investigated against MRSA. The most active fractions (F-3 and F-4) led to the isolation of oregonin (ORE) and hirsutanone (HIR). These compounds were active against MRSA strains with minimum inhibitory concentrations (MICs) ranging from 31.25 to 250 microg/ml MIC and 2 MIC of HIR completely inhibited the growth of MRSA.

CONCLUSIONS

The bark EtOH extract of Alnus Pendula has potent antibacterial activity against MRSA.

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

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

Antimicrobial activity of the constituents of Smallanthus sonchifolius leaves against methicillin-resistant Staphylococcus aureus

BACKGROUND AND OBJECTIVES

Methicillin-resistant Staphylococcus aureus (MRSA) has been a serious problem as its infection is associated with higher mortality and increase cost worldwide. In the present study, the antibacterial activity of enhydrin, polymatin B, allo-schkuhriolide from the leaves of Smallanthus sonchifolius was investigated.

MATERIAL AND METHODS

Enhydrin, polymatin B, allo-schkuhriolide from the leaves of Smallanthus sonchifolius were tested for antimicrobial activity using micro dilution broth method against 2 strains of ATCC 33591, ATCC 25923 and 15 strains of clinical isolates MRSA.

RESULTS

The antibacterial activity of Smallanthus sonchifolius can safely be attributed to enhydrin as polymatin B, and allo-schkuhriolide are not showing any activity against Staphylococcus aureus strains. The enhydrin showed good antibacterial activity against all tested strains (MIC = 125-500 microg/ml).

DISCUSSION

These results suggest that only enhydrin can be considered as an antibacterial drug against MRSA.

Bio-separation of toxic arsenate ions from dilute solutions by native and pretreated biomass of Aspergillus fumigatus in batch and column mode: effect of biomass pretreatment

The sorption of As(V) from aqueous solution onto live and pretreated biomass of Aspergillus fumigatus was studied. The studies on optimization of contact time, adsorbent dosage and pH showed that the FeCl(3) treated and FeSO(4) treated biomass had the maximum capacity to adsorb As(V) while acid treated biomass was found to be minimum. Adsorption parameters were determined using both Langmuir and Freundlich isotherm models. The maximum adsorption capacity of 0.054 mg/g was observed in FeCl(3) treated and FeSO(4) treated biomasses. Column mode studies were conducted using FeSO(4) treated biomass to compare its efficacy with batch mode to adsorb As(V). Batch mode experiments proved to be efficient. Desorption studies were also carried out with dilute sodium hydroxide to recover both the adsorbent and adsorbate.

Organic micro-pollutant removal in liquid-phase using carbonized silk cotton hull

Phenolic compounds constitute one of the major pollutants in the modern world. Although many physical and chemical treatment technologies for their removal exist, most of them are economically not feasible. The present study was aimed at using silk cotton hull, a potent agricultural waste as an adsobent for removal of 2,4-dichlorophenol (2,4-DCP), which was used as a model phenolic compound. The process parameters were investigated and optimized conditions were determined. The equilibrium time was found to be 60 and 80 min for 10 and 20 mg/L and 100 min for 30 and 40 mg/L 2,4-DCP concentrations, respectively. Among the kinetic models applied, pseudo-second order model fitted well. The maximum adsorption capacity was 16.0 mg/g by Langmuir isotherm. Acidic pH was found favorable for the adsorption of 2,4-DCP. Studies on pH effect and desorption seemed to show that chemisorption played a major role in the adsorption process. In thermodynamic study, the change in entropy (DeltaS0) and heat of adsorption (DeltaH0) of silk cotton hull carbon (SCHC) was estimated as 14.01 J/(mol x K) and 3.04 kJ/mol, respectively. SCHC as adsorbent for removal of 2,4-DCP from aqueous solution, is effective, inexpensive, indigenous, reusable, has low treatment time and is easily available in large quantities as waste there by significantly lowers the cost of wastewater treatment.

Effects of Homologous and Heterologous Neuraminidase Vaccines in Chickens Against H5N1 Highly Pathogenic Avian Influenza

The 2004 Asian H5N1 epizootic outbreak indicates the urgent need for vaccines against highly pathogenic avian influenza (HPAI) virus. The manufacture of inactivated whole-virus vaccines from HPAI viruses by traditional methods is not feasible for safety reasons as well as technical issues. The low pathogenic avian influenza A/wild bird feces/CSM2/02 (H5N3) virus was used as a heterologous neuraminidase vaccine, and HPAI A/CK/Korea/ES/03 (H5N1) virus was used as a homologous neuraminidase vaccine. Protection efficacy of both vaccines was evaluated by clinical signs, mortality rates, and virus shedding from oropharynx and cloaca of vaccinated chickens after challenge with HPAI A/CK/Korea/ES/03 (H5N1) virus. One dose of 128 hemagglutinin (HA) homologous H5N1 vaccine induced 100% protection in mortality and prevented viral shedding completely after lethal dose virus challenge, whereas one dose of 64 HA unit of heterologous H5N3 vaccine only induced 50% protection in mortality, and it did not prevent viral shedding. However, two doses at a 3-wk interval of 64 HA unit of heterologous H5N3 vaccine as well as one dose of 1024 HA unit of heterologous H5N3 vaccine induced 100% survival rate and could prevent viral shedding completely. Furthermore, we could differentiate the sera of infected birds from those of vaccinated birds by indirect immunofluorescent antibody test. These results suggest that heterologous neuraminidase H5N3 vaccine could be a useful tool for the control of H5N1 HPAI epidemic in poultry.

Transdermal delivery of ketoprofen using microemulsions

A transdermal preparation containing ketoprofen was developed using O/W microemulsion system. Of the oils tested, oleic acid was chosen as the oil phase of the microemulsion, as it showed a good solubilizing capacity and excellent skin permeation rate of the drug. Pseudoternary phase diagrams were constructed to obtain the concentration range of oil, surfactant and cosurfactant for microemulsion formation, and the effect of these additives on skin permeation of ketoprofen was evaluated with excised rat skins. The optimum formulation of the microemulsion consisted of 3% ketoprofen, 6% oleic acid, 30% Labrasol/Cremophor RH 40 (1:1) and water. Terpenes were added to the microemulsion at the level of 5% and their effect on the skin permeation of ketoprofen from the microemulsion was evaluated. Of the four terpenes used, only limonene resulted in a powerful enhancing activity (3-fold increase over control).

Domain and genomic sequence analysis of bdellin-KL, a leech-derived trypsin-plasmin inhibitor

Bdellin-KL is a trypsin-plasmin inhibitor from Hirudo nipponia, whose N-terminal sequence was identified as a non-classical Kazal-type. A cDNA clone encoding the inhibitor was isolated by reverse transcription-PCR and 5' rapid amplification of cDNA ends. The cDNA showed an open reading frame of 155 amino acids comprising one signal peptide and two separated domains. The C-terminal domain consists of distinct internal repeats, including HHEE and HHDD. The bdellin-KL sequence, from the constructed genomic library of Korean leech, was determined for the 2109 bases comprising the open reading frame and flanking regions (3' and 5'). The promoter region contains potential regulatory sequence motifs, including TATA, CAAT, and GC boxes. To characterize the properties of each domain, an N-terminal fragment was prepared by limited proteolysis of the intact protein. The inhibitory activity of the region was as potent as that of the intact protein. This suggests that the compact domain plays an important part in the inhibitory action of bdellin-KL. The C-terminal domain was revealed to have binding affinity to ions such as Ca(2+), Zn(2+), Fe(3+), and Fe(2+) without an influence on the inhibitory activity. This study demonstrates that bdellin-KL may be a novel bifunctional protein with two distinct domains.

Electrophoretron: a new method for enhancing resolution in electrokinetic separations

Two capillaries, each of which have different surface preparations on their inside walls, are joined together to form a closed loop, and electrodes are placed inside the two capillaries. When the loop is filled with liquid and a potential difference is applied between the two electrodes, a circulating flow of liquid is established inside the loop because the resistance to flow is unequal in going from one electrode to another in a clockwise versus a counterclockwise direction. Consequently, a sample injected into this device, which we call an electrophoretron, repeatedly circulates between the two electrodes and the capillary separation column becomes effectively one of unlimited length. On each cycle the separation between analytes with different mobilities increases, thus enhancing resolution of analytes having nearly the same mobilities. The operation of a prototype electrophoretron is demonstrated.

Apoptosis, bcl2 expression, and cell cycle analyses in nickel(II)-treated normal rat kidney cells

Nickel compounds are carcinogenic to human and are potent inducers of kidney and lung tumors in experimental animals. In this study, the effects of nickel(II) acetate on apoptosis, cell cycle and bcl2 expression in normal rat kidney (NRK- 52E) cells were investigated. Nickel(II) induced apoptosis in NRK-52E cells as demonstrated by DNA laddering. Apparent DNA laddering was observed in cells treated with 480 microM for 48 hr. In the flow cytometric analysis using propidium iodide fluorescence, an increase of cell proportion in G2/M phase was shown in cells exposed to at least 320 microM of nickel(II) acetate, from 7.7% for 0 microM of nickel(II) to 16.5% for 480 microM of nickel(II) acetate. Induction of apoptotic cell death by nickel(II) was accompanied by reduction of bcl2 protein expression, while the level of p53 protein was not changed. Taken together, our data indicate that nickel(II)-induced apoptosis in NRK-52E cells is accompanied by G2/M cell cycle arrest, regardless of p53 function, and that bcl2-mediated signaling pathway may be involved in positive regulation of nickel(II)-induced apoptotic cell death in NRK-52E cells.

Multiple lentigines syndrome: a comparison of normal skin and lentiginous skin by electron microscopy and immunohistochemical staining

A 26-year-old Korean man exhibited generalized lentigines, a slight prominence of the chin, short stature, and a familial history consistent with the autosomal dominant mode of inheritance. The multiple lentigines appeared at the age of 1 and spread over his entire body including the scalp, palms, and soles by the age of 4. There were several large dark pigmented spots on the trunk, but no other skin abnormalities were found. We performed histologic studies of the normal skin and the lentigo by both electron and light microscopy with immunohistochemical stains. Routine hematoxylin-eosin staining of the pigmented skin revealed heavily pigmented basal and spinous layers and prominent rete ridges. Fontana-Masson stain showed enormous black pigmentations on the basal and spinous layers of the pigmented macule. S-100 protein stain of the pigmented lesion demonstrated an increased number of melanocytes per unit skin area. Ultrastructural studies showed the presence of extensive aggregated melanosomes within the keratinocytes in the epidermis of lentigo, but not the presence of giant melanosomes in either normal skin or lentigines.

Laser schlieren microphone for optoacoustic spectroscopy

This paper describes a laser schlieren microphone, where a low-power He-Ne laser beam is deflected by a reflecting diaphragm mounted on an optoacoustic Helmholtz resonator. The sinusoidal pressure variations in the resonator distort the surface of the diaphragm so that the reflected laser beam is alternately focused and defocused. The deflection is converted into an amplitude modulation of the beam by an iris located at a distance from the resonator and detected with a photodiode. The light beam can be modulated at a high frequency and the signal from the photodiode processed with a lock-in amplifier so that noise with a power spectral density proportional to the inverse of the frequency is significantly reduced in the final optoacoustic signal. A mathematical description of the laser schlieren microphone is given that shows the system to respond linearly to small signals. An experiment was done to determine the range of linear response of the microphone to large amplitude optoacoustic signals.