Comparison of pain relief in soft tissue tumor excision: anesthetic injection using an automatic digital injector versus conventional injection

Background@#The pain caused by local anesthetic injection can lead to patient anxiety prior to surgery, potentially necessitating sedation or general anesthesia during the excision procedure. In this study, we aim to compare the pain relief efficacy and safety of using a digital automatic anesthetic injector for local anesthesia. @*Methods@#Thirty-three patients undergoing excision of a benign soft tissue tumor under local anesthesia were prospectively enrolled from September 2021 to February 2022. A single-blind, randomized controlled study was conducted. Patients were divided into two groups by randomization: the experimental group with digital automatic anesthetic injector method (I-JECT group) and the control group with conventional injection method. Before surgery, the Amsterdam preoperative anxiety information scale was used to measure the patients’ anxiety. After local anesthetic was administered, the Numeric Pain Rating Scale was used to measure the pain. The amount of anesthetic used was divided by the surface area of the lesion was recorded. @*Results@#Seventeen were assigned to the conventional group and 16 to the I-JECT group. The mean Numeric Pain Rating Scale was 1.75 in the I-JECT group and 3.82 in conventional group. The injection pain was lower in the I-JECT group (p< 0.01). The mean Amsterdam preoperative anxiety information scale was 11.00 in the I-JECT group and 9.65 in conventional group. Patient’s anxiety did not correlate to injection pain regardless of the method of injection (p= 0.47). The amount of local anesthetic used per 1 cm 2 of tumor surface area was 0.74 mL/cm2 in the I-JECT group and 2.31 mL/cm2 in the conventional group. The normalization amount of local anesthetic was less in the I-JECT group (p< 0.01). There was no difference in the incidence of complications. @*Conclusion@#The use of a digital automatic anesthetic injector has shown to reduce pain and the amount of local anesthetics without complication.

Reconstruction of a large lower lip defect using a combination of Abbe and staircase flaps: a case report

Lip defects often occur following wide excision as a surgical treatment for squamous cell carcinoma of the oral cavity. Defects larger than one-half of the lip cannot be closed primarily and require flap surgery. Reconstruction of the oral sphincter function can be achieved by means of a local flap using the like tissue, rather than with a free flap utilizing different tissues. A defect of the lower lip requires reconstruction using different techniques, depending on its size and location. Herein, we present the case of a patient exhibiting a lip defect spanning more than two-thirds of the lower lip, after a wide resection due to squamous cell carcinoma. The defect was reconstructed using an Abbe flap and a staircase flap. Revision was performed after 16 days. The patient’s oral competencies were fully restored 3 months postoperatively, and the esthetic results were ideal. Based on our experience, a combination of the Abbe and staircase flaps can produce excellent functional and esthetic outcomes in the reconstruction of a lower lip with a large defect. It can serve as a reliable reconstruction option for defects spanning more than two-thirds of the lower lip, not including the oral commissures.

Generation of knockout mouse models of cyclin-dependent kinase inhibitors by engineered nuclease-mediated genome editing / 한국실험동물학회지

Cell cycle dysfunction can cause severe diseases, including neurodegenerative disease and cancer. Mutations in cyclin-dependent kinase inhibitors controlling the G1 phase of the cell cycle are prevalent in various cancers. Mice lacking the tumor suppressors p16(Ink4a) (Cdkn2a, cyclin-dependent kinase inhibitor 2a), p19(Arf) (an alternative reading frame product of Cdkn2a,), and p27(Kip1) (Cdkn1b, cyclin-dependent kinase inhibitor 1b) result in malignant progression of epithelial cancers, sarcomas, and melanomas, respectively. Here, we generated knockout mouse models for each of these three cyclin-dependent kinase inhibitors using engineered nucleases. The p16(Ink4a) and p19(Arf) knockout mice were generated via transcription activator-like effector nucleases (TALENs), and p27(Kip1) knockout mice via clustered regularly interspaced short palindromic repeats/CRISPR-associated nuclease 9 (CRISPR/Cas9). These gene editing technologies were targeted to the first exon of each gene, to induce frameshifts producing premature termination codons. Unlike preexisting embryonic stem cell-based knockout mice, our mouse models are free from selectable markers or other external gene insertions, permitting more precise study of cell cycle-related diseases without confounding influences of foreign DNA.

Association between Genetic Variations of MERTK and Chronic Obstructive Pulmonary Disease in Koreans

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease. To date, a large number of clinical studies have been conducted to investigate the association between genetic variations and COPD. However, little is known regarding the genetic susceptibility of Koreans to this disease. MER receptor tyrosine kinase (MERTK) plays important roles in the inhibition of inflammation and in the clearance of apoptotic cells. Here, we investigated the association between genetic variations in MERTK and the development of COPD in Koreans. METHODS: We conducted genetic analysis of MERTK using genomic DNA samples from 87 patients with COPD and 88 healthy controls and compared the frequency of each variation or haplotype between the patient and control groups. Subsequently, the effect of each variation was evaluated using in vitro assays. RESULTS: Ten variations were identified in this study, four of them for the first time. In addition, we found that the frequency of each variation or haplotype was comparable between the patient and control groups. However, we observed that the frequency for the wild-type haplotype was higher in the control group, compared to that in the group of patients with COPD, in the subgroup analysis of current smokers, although the difference was not statistically significant (P = 0.080). In in vitro assays, we observed that none of the variations affected the activity of the promoter or the expression of MERTK. CONCLUSION: Our findings indicate that the susceptibility to COPD is not related to the genetic variations or haplotypes of MERTK in Koreans.

Personality Types and Application to Medical Education in Medical Students / 계명의대학술지

Myers-Briggs Type Indicator (MBTI) is a personality type test book, which is widely used in the field of personal counseling, team organization, school education and research. This study carried out MBTI of 361 medical students in the second grade of premedical course of Keimyung University School of Medicine from 2014 to 2018, and analyzed the data to use them for the students' education. The personality type was mostly distributed to ISTJ, ISTP, ESTP and ESTJ in order among 16 types. According to preference tendency, it was found out that the introverted type was extroverted, the recognition type was intuition type, the thinking type was emotional type, and the recognition type was more distributed than the judgment type. The psychological functions were ST, SF, NF, NT. MBTI type analysis of medical students shows that it is possible to organize members in group activities to improve their ability to understand themselves and understand others in class scenes. In addition, we expect to be able to design for improvement of stress management, conflict management, and communication ability. In the career counseling scene, in addition to the MBTI data analysis, it is expected that it will be possible to recommend a major suitable for the student personality type in parallel with other psychological tests. In addition, we expect to study the preferred field of study, satisfaction with the major in the future research by continuous data accumulation and analysis.

Knowledge Discovery-oriented Biomedical Literature Information Retrieval and Visualization Design / 医学信息学杂志

The paper discusses influence and effect of information retrieval process of biomedical literature and visualization design on user knowledge discovery,from the aspects of input and output,retieval process and information positioning,it introduces the interaction model of literature information retrieval process and analyzes approach of literature information visualization design,including color and font,statistical chart,list of categories and labels,layer structure and network pictures,etc.

Effect of paper publication time on knowledge discovery in biomedical literature / 中华医学图书情报杂志

The effect of paper publication time on knowledge discovery in biomedical literature was studied by analyzing the role of time factor in indirect link mining and tested using the PubMed-covered data set,which showed that recently published papers played a better role than early published papers in knowledge discovery,indicating that the time factor plays a certain role in knowledge discovery in biomedical literature and can thus improve the efficiency of knowledge discovery in biomedical literature.

The Effect of Strong-weak Connection on Medical Literature Knowledge Discovery / 医学信息学杂志

The paper analyzes different expressions of indirectly associated strong-weak connection in the process of biomedical literature knowledge discovery,defines the effect and function of strong-weak connection on literature knowledge discovery,and indicates that the accuracy rate of the discovery of potential connection through strong connection is obviously higher than the accuracy rate obtained through weak connection,and strong connection can serve as an important factor for improving the application effect of literature knowledge discovery.

Role of network characteristics in evaluation of literature-based indirect association discovery / 中华医学图书情报杂志

New scientific hypotheses detected by mining the potential indirect association inliterature according to the studies on literature-based knowledge discovery are increasinglyapplied in biomedical field and evaluation of literature-based indirect association discovery is a hot spot in recent studies on literature-based knowledge discovery . The role of network characteristics in evaluation of literature-based indirect association discovery during the litera-ture-based knowledge discovery was thus studied.The new indexes for evaluaing the literature-based indirect asso-ciation discovery were esatablished by integrating the co-ocurrent statistic information and the network charateris-tics, which are of greatimportance for improving literature-based knowledge discovery and constructing knowledge discovery system .

Differentiation of bone marrow mesenchymal stem cells induced by continuous cell culture / 医学研究生学报

[Abstract ] Objective Bone marrow mesenchymal stem cells(BMSCs) can be induced to the differentiation into vascular smooth muscle cells in many induction conditions.We sought to explore the possibility of the differentiation of mesenchymal stem cells into vascular smooth muscle cells by continuous cell culture in vitro. Methods Rat BMSCs were isolated from the bilateral tibial and femoral bones by the method of whole bone marrow adherence, followed by ex vivo expansion.BMSCs were identified by flow cytometry and three-lineage differentiation.After continuous five days'cell culture of BMSCs, the specific surface antigens of VSMCs were detec-ted by immunofluorescence, western blot and real-time PCR. Results BMSCs expressed CD29、90, in contrast, they did not express CD45、34、49d.After induction of osteogenesis, adipogenesis and chondrogenesis, alizarin red、oil red and alcian blue staining pro-duced a strong reaction in cells.The expressions ofα-SMA、Calponin1、SM-MHC and SM22 in the cells of experimental group were no-tably increased, which indicated that BMSCs were differentiating towards VSMCs. Conclusion In the absence of exogenous stimula-tion, BMSCs can be successfully induced to differentiate into VSMCs by continuous cell culture.

Culture and Identification of Bone Marrow Mesenchymal Stem Cells from Enhanced Green Fluorescent Protein-transgenic Rats / 中国医学科学院学报

<p><b>OBJECTIVE</b>To isolate, culture, and identify bone marrow mesenchymal stem cells (BMSCs) from enhanced green fluorescent protein (EGFP)-transgenic rats in vitro.</p><p><b>METHODS</b>Bone marrows were isolated from tibia and femur of healthy EGFP-transgenic rats of specific pathogen free (SPF) grade. Then,the whole bone marrow adherent method was used for isolation,culture,and purification of BMSCs. The morphological change was noted by continuous observation under inverted fluorescence microscope. The growth curve of cells was drawn through the method of CCK-8 and the proliferation compared with wild type BMSCs. The surface markers of BMSCs were detected by flow cytometry. The BMSCs were induced to differentiate into osteoblasts, adipocytes, and chondrocytes lineages. The EGFP-BMSCs were transplanted into the rats intravenously, and the expression of GFP was detected.</p><p><b>RESULTS</b>BMSCs stably expressing EGFP gene were obtained successfully, with the fusiform-shaped appearance and the forming of circinate cell colonies. The growth curve of EGFP-MSCs showed the characteristic of active proliferation, showing no significant difference compared with the wild-type BMSCs. The expression rates of the surface markers of BMSCs CD29, CD90, CD34, CD49d, and CD45 were 99.4%, 96.4%, 0.171%, 0.049%, and 0.038%. The GFP were detected in lung 3 days after transplantation. After osteogenic, adipogenic, and chondrogenic induction, oil red-O and alizarin red positive signals and toluidine blue positive cells were detected.</p><p><b>CONCLUSIONS</b>High-purity BMSCs stably expressing green fluorescent protein gene can be cultured using the whole bone marrow adherent method. EGFP does not affect the stem cell properties and expresses stably after transplantation. The cells can be used as seed cells for subsequent research.</p>

Effect of Lights-Out at Night Time on Body Weight, Physiological Variables, and Behavioral Status in Premature Infants

PURPOSE: This study was conducted to assess the effects of lights-out at nighttime on body weight, physiological variables, and behavioral status in premature infants and to provide basic data for applying lights-out at night time in premature infants. METHODS: Premature infants of over 32 weeks' corrected age were included in this study (January 2015-June 2015), and were allocated to two groups according to the lights-out at night for 5 hours: study group and control group. Lights-out was applied to the study group from midnight for five hours in a quiet environment. RESULTS: Fifty-two infants were included in the study: 26 in the study group and 26 in the control group. Growth rates of body weight, height, and head circumference were higher in the study group compared to the control group, but there were no statistical differences. In the physiological variables, heart rate decreased by 6.9 beats per minute in the study group, but it increased by 2.7 beats per minute in the control group (P<0.0001) during applied 5 hours at night. Anderson Behavioral State Score decreased in the study group compared to the control group (P=0.042). CONCLUSION: Lights-out at night decreased the heart rate and made the behavioral status more stable. To understand the effects of lights-out on long-term growth and development of premature infants at the highest risk of delayed growth and development, further studies with a larger number of premature infants are needed.

Effects of Combination Treatment of Alpha 1-Adrenergic Receptor Antagonists on Voiding Dysfunction: Study on Target Organs in Overactive Bladder Rats / 대한배뇨장애요실금학회지

PURPOSE: Overactive bladder (OAB) causes urinary urgency, usually accompanied by frequency and nocturia. Alpha 1-adrenergic receptor (α1-AR) antagonists are known to improve lower urinary tract symptoms associated with OAB. The α1-AR antagonists constitute a variety of drugs according to the receptor subtype affinity. This study investigated the efficacy of tamsulosin, naftopidil, and a combination of the two on OAB rats. METHODS: The OAB rat model was induced by an intraperitoneal injection of cyclophosphamide for 14 days. The experimental groups were divided into 5 groups: control group, OAB-induction group, OAB-induction and tamsulosin monotherapy group, OAB-induction and naftopidil monotherapy group, and OAB-induction and tamsulosin-naftopidil combination therapy group. For the drug-treated groups, each drug was administrated for 14 days after the OAB induction. Cystometry for urodynamic evaluation and immunohistochemical stain for c-Fos and nerve growth factor (NGF) expressions in the central micturition centers were performed. RESULTS: Increased contraction pressure and time with enhanced c-Fos and NGF expressions in the central micturition centers were found in the OAB rats. Tamsulosin suppressed contraction pressure and time while inhibiting c-Fos and NGF expressions. Naftopidil showed no significant effect and combination therapy showed less of an effect on contraction pressure and time. Naftopidil and combination therapy exerted no significant effect on the c-Fos and NGF expressions. CONCLUSIONS: Tamsulosin showed the most prominent efficacy for the treatment of OAB compared to the naftopidil and combination. The combination of tamsulosin with naftopidil showed no synergistic effects on OAB; however, further studies of addon therapy might provide opportunities to find a new modality.

Effects of Combination Treatment of Alpha 1-Adrenergic Receptor Antagonists on Voiding Dysfunction: Study on Target Organs in Overactive Bladder Rats / 대한배뇨장애요실금학회지

PURPOSE: Overactive bladder (OAB) causes urinary urgency, usually accompanied by frequency and nocturia. Alpha 1-adrenergic receptor (α1-AR) antagonists are known to improve lower urinary tract symptoms associated with OAB. The α1-AR antagonists constitute a variety of drugs according to the receptor subtype affinity. This study investigated the efficacy of tamsulosin, naftopidil, and a combination of the two on OAB rats. METHODS: The OAB rat model was induced by an intraperitoneal injection of cyclophosphamide for 14 days. The experimental groups were divided into 5 groups: control group, OAB-induction group, OAB-induction and tamsulosin monotherapy group, OAB-induction and naftopidil monotherapy group, and OAB-induction and tamsulosin-naftopidil combination therapy group. For the drug-treated groups, each drug was administrated for 14 days after the OAB induction. Cystometry for urodynamic evaluation and immunohistochemical stain for c-Fos and nerve growth factor (NGF) expressions in the central micturition centers were performed. RESULTS: Increased contraction pressure and time with enhanced c-Fos and NGF expressions in the central micturition centers were found in the OAB rats. Tamsulosin suppressed contraction pressure and time while inhibiting c-Fos and NGF expressions. Naftopidil showed no significant effect and combination therapy showed less of an effect on contraction pressure and time. Naftopidil and combination therapy exerted no significant effect on the c-Fos and NGF expressions. CONCLUSIONS: Tamsulosin showed the most prominent efficacy for the treatment of OAB compared to the naftopidil and combination. The combination of tamsulosin with naftopidil showed no synergistic effects on OAB; however, further studies of addon therapy might provide opportunities to find a new modality.

Complex associated network-based biomedical research structure mining / 中华医学图书情报杂志

A biomedical entity association evolution network was constructed by mining the implicit associations in PubMed-covered literature, which can help scientific researchers to form new scientific hypotheses, to analyze the topological features of associated network, to study the scientific literature-enriched knowledge structure, associa-tions, development rules, to introduce new visual angles and methods for literature-based knowledge discovery, and to improve the knowledge discovery efficiency.

Multiple Papillary Fibroelastomas and Thrombus in the Left Heart

Cardiac papillary fibroelastomas (CPF) are benign cardiac tumors and usually discovered incidentally during echocardiography. This report describes the case of a 68-year-old man, referred to cardiology for multiple masses of the left ventricle and left atrium. The transthoracic echocardiography revealed multiple oscillating masses in the left ventricle and aortic valve, non-mobile mass in the left atrium with severe mitral stenosis and moderate aortic regurgitation. The patient underwent surgical resection of the masses with valve replacements. Histopathologic examination confirmed the diagnosis of CPF in the left ventricle and aortic valve, thrombus in the left atrium.

Fatal Subacute Stent Thrombosis Induced by Guidewire Fracture with Retained Filaments in the Coronary Artery

During percutaneous coronary intervention, guidewire fractures are very exceptionally encountered in medical practice, but can cause fatal complications such as intracoronary thrombus formation, embolization and perforation. Removal of the remnant segments of guidewire is important for the prognosis. There are several methods being recommended for the treatment of fractured guidewire remnants. However, the best treatment of remnant guidewire filament is still unclear. Herein, we present a case where we did not completely remove remnant guidewire filaments that caused fatal coronary thrombosis.

Fatal acute right heart failure in gastric cancer patients

Pulmonary tumor thrombotic microangiopathy [PTTM] is a rare condition causing pulmonary artery hypertension and acute right heart failure in patients with cancer. However, chest computer tomography shows negative finding of pulmonary thromboembolism. Serum D-dimer level may be elevated. Echocardiography reveals a dilated right ventricle and feature of pulmonary artery hypertension. Establishing this diagnosis can be very difficult, and most cases are diagnosed during autopsy, although a history of cancer may be a predictor. PTTM should be considered in all patients with apparent pulmonary artery hypertension and elevated D-dimer level, particularly when the patient is known to have an underlying malignancy, especially adenocarcinoma and most of all, the clinical manifestation is very rapidly progressive.

Low Pressure Pulmonary Artery Aneurysm with Atrial Septal Defect

Pulmonary artery (PA) aneurysm is a rare finding in the thoracic cavity, accompanied by pulmonary hypertension. Clinical presentation of PA aneurysms is usually asymptomatic. The guideline for PA aneurysm treatment is unclear. We report an unusual case of low pressure PA aneurysm associated with atrial septal defect in a 69-year-old man.

Four Year Trend of Carbapenem-Resistance in Newly Opened ICUs of a University-Affiliated Hospital of South Korea / 결핵및호흡기질환

BACKGROUND: Carbapenem-resistance is rapidly evolving among the pathogenic microbes in intensive care units (ICUs). This study aimed to determine annual trend of carbapenem-resistance in the ICU for 4 years, since the opening of a university-affiliated hospital in South Korea. METHODS: From 2005 to 2008, microbial samples from consecutive 6,772 patients were screened in the ICU. Three hundred and ninety-seven patients (5.9%) and their first isolates of carbapenem-resistant pathogens were analyzed. RESULTS: The percentage of patients infected with carbapenem-resistant organisms increased constantly during the initial three years (2.3% in 2005, 6.2% in 2006, 7.8% in 2007), then it declined to 6.5% in 2008. Acute Physiology and Chronic Health Evaluation (APACHE) III score at admission was 58.0+/-23.5, the median length of the ICU stay was 37 days, and the mortality rate was 37.5%. The sampling sites were endotracheal suction (67%), catheterized urine (17%), wound (6%) and others (10%). Bacteria with carbapenem-resistance were Pseudomonas aeruginosa (247 isolates, 62%), Acinetobacter baumannii (117 isolates, 30%), Enterobacteriaceae (12 isolates, 3%), and others (21, 5%). Of note, peak isolation of carbapenem-resistant microorganisms in medical ICU was followed by the same epidemic at surgical ICU. CONCLUSION: Taken together, carbapenem-resistant pathogens are of growing concern in the ICU.