An adaptive DC-balanced and multi-mode stimulator IC with 1GΩ output impedance for compact electro-acupuncture system.

A compact and low-power electro-acupuncture (EA) IC and its Premeasurement System as off-chip board for verification are proposed for medical treatment and experiment. The multi-mode stimulator EA IC can perform adaptive charge balancing with various load condition as well as programmable supply voltage for 5 different stimulation modes. The proposed EA IC occupies 2.2 mm × 1.5 mm including pads manufactured through 0.11 µm 1P6M CMOS technology and dissipates 1.8 mW at 1.2 V supply supporting 256 different current level with >1G output impedance. The Premeasurement System with corresponding specification to the proposed fabricated EA IC is fully implemented and tested on the human body and animal.

The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

An Alternative Triage Strategy Based on Preoperative MRI for Avoiding Trimodality Therapy in Stage IB Cervical Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Adjuvant chemoradiation following primary surgery is frequently indicated in patients with stage IB cervical cancer. The aim of this study is to evaluate the role of a magnetic resonance imaging (MRI)-based strategy in avoiding trimodality therapy. MATERIALS AND METHODS: We retrospectively reviewed all patients with stage IB cervical cancer treated initially with primary surgery at Seoul National University Hospital. We suggest an alternative triage strategy in which the primary treatment modality is determined based on preoperative MRI findings. Using this strategy, primary surgery is only indicated when there is no evidence of parametrial involvement (PMI) and lymph node metastasis (LNM) in the MRI results; when there is evidence of either or both of these factors, primary chemoradiation is selected. Assuming that this strategy is applied to our cohort, we evaluate how the rate of trimodality therapy is affected. RESULTS: Of the 254 patients in our sample, 77 (30.3%) had at least one category 1 risk factor (PMI, LNM, positive resection margin) upon pathologic examination. If the MRI-based strategy had been applied to our cohort, 168 patients would have undergone primary surgery and 86 would have undergone primary chemoradiation. Only 25 patients (9.8%) would have required trimodality therapy based on an indication of at least one category 1 pathologic risk factor following radical hysterectomy. CONCLUSION: The inclusion of MRI in the decision-making process for primary treatment modality could have reduced the number of patients requiring trimodality therapy based on the indication of a category 1 risk factor from 30.3% to 9.8% in our cohort.

Expression of the S glycoprotein of transmissible gastroenteritis virus (TGEV) in transgenic potato and its immunogenicity in mice / 대한수의학회지

Transgenic plants have been tested as an alternative host for the production and delivery of experimental oral vaccines. Here, we developed transgenic potatoes that express the major antigenic sites A and D of the glycoprotein S from transmissible gastroenteritis coronavirus (TGEV-S0.7) under three expression vector systems. The DNA integration and mRNA expression level of the TGEV-S0.7 gene were confirmed in transgenic plants by PCR and northern blot analysis. Antigen protein expression in transgenic potato was determined by western blot analysis. Enzyme-linked immunosorbent assay results revealed that based on a dilution series of Escherichia coli-derived antigen, the transgenic line P-2 had TGEV-S0.7 protein at levels that were 0.015% of total soluble proteins. We then examined the immunogenicity of potato-derived TGEV-S0.7 antigen in mice. Compared with the wild-type potato treated group and synthetic antigen treated group, mice treated with the potato-derived antigen showed significantly higher levels of immunoglobulin (Ig) G and IgA responses.

Major clinical research advances in gynecologic cancer in 2012 / 부인종양

Ten topics were chosen among major clinical research achievements in gynecologic oncology in 2012. For ovarian cancer, comprehensive review of the history of bevacizumab studies was followed by poly adenosine diphosphate [ADP]-ribose polymerase (PARP) inhibitors and other molecular targeted agents such as epidermal growth factor receptor tyrosine kinase inhibitor and AMG 386. For the development of genomic study in gynecologic cancers, BRCA and DICER1 mutations were covered in epithelial and nonepithelial ovarian cancer, respectively. For endometrial cancer, targeted agents including mammalian target of rapamycin (mTOR) inhibitors and bevacizumab were discussed. Radiation therapy "sandwiched" between combination chemotherapy schedules for the treatment of uterine papillary serous carcinoma was also reviewed. Preoperative prediction of lymph node metastasis, definition of low-risk group, and recurrence and survival outcomes of laparoscopic approaches were addressed. For cervical cancer, we reviewed long-term benefit of human papillomavirus test and efficacy of paclitaxel/carboplatin versus paclitaxel/cisplatin in stage IVB, persistent or recurrent disease. In addition, the effect of three dimensional image-based high-dose rate brachytherapy was also reviewed. For vulvar cancer, the diagnostic value of sentinel lymph node biopsy was discussed. For breast cancer, positive results of three outstanding phase III randomized clinical trials, CLEOPATRA, EMILIA, and BOLERO-2 were introduced. Lastly, updates of major practice guidelines were summarized.

Comparison between Emergency Patient Poisoning Cases and the Tox-Info System Database

PURPOSE: The Tox-Info system is a poisonous substance information database developed by the Korean National Institute of Food and Drug Safety Evaluation. The aim of this study was to estimate the coverage effectiveness of the Tox-Info system by comparing the toxic substances included in the database with the distribution of the toxic substances implicated in the cases of intoxicated patients presenting to emergency departments. The secondary aim of the study was to propose any additional substances that should be added to the database. METHODS: We retrospectively reviewed the medical records of patients suffering with toxic exposure who had visited any of 12 selected emergency departments in Korea from January 2010 to December 2011. The identified toxic substances were classified into groups including prescription drugs, agricultural chemicals, household products, animals or plants, herbal drugs, and others. We calculated the coverage rate of the Tox-Info database relative to the number of intoxication cases and the type of toxic substances involved. RESULTS: A total of 5,840 intoxicated patient records were collected. Their mean age was 46.6+/-20.5 years and 56.2% were female. Of the total intoxication cases, 87.8% of the identified toxic substances were included in the Tox-Info database, while only 41.6% of all of the types of identified toxic substances were included. Broken down by category, 122 prescription drugs, 15 agricultural chemicals, 12 household products, 14 animals or plants and 2 herbal drugs involved in poisoning cases were not included in the Tox-info database. CONCLUSION: This study demonstrated the clinical usefulness of the Tox-Info system. While 87.8% of the substances involved in the cases were included in the Tox-Info database, the database should be continuously updated in order to include even the most uncommon toxic substances.

A Case of Tumoral Calcinosis in a Hemodialysis Patient with Secondary Hyperparathyroidism / 대한신장학회지

Tumoral calcinosis is a periarticular calcific lesion and rare complication in patients with maintenance hemodialysis. The pathogenesis of tumoral calcinosis is poorly understood but may be due to elevated serum phosphorus, a high calcium phosphorus (Ca x P) product or secondary hyperparathyroidism in hemodialysis patients. A 30-year-old man presented with pain and palpable mass of left shoulder. He had been on maintenance hemodialysis with high flux dialyzer for 10 years. Laboratory finding showed hyperphosphatemia and elevated intact PTH concentration. A shoulder X-ray and CT scan demonstrated a massive calcification. Following partial resection, pain was relieved. Here we report a case of tumoral calcinosis of shoulder in a hemodialysis patient with untreated hyperphosphatemia and secondary hyperparathyroidism.

Usefulness of Local Anesthesia for Urethral Catheterization

PURPOSE: Urethral catheterization is a commonly done, painful procedure, but few studies have evaluated the use of topical anesthesia prior to catheterization. This study was designed to assess the effect of topical anesthetics (2% lidocaine gel) prior to uretheral catheterization. METHODS: This study was a prospective, randomized, case-controlled trial conducted in an emergency department of a university teaching hospital. The 54 subjects were alert, cooperative male adults. Patients in the experimental group were catheterized after injection of topical lidocaine gel in their urethras, and a wait of 3 minutes. Patients in the control group were catheterized with a urethral catheter that was coated by plain lubricant. After each procedure, the patients indicated their subjective assessment of pain on a 100 mm visual analog scale (VAS). We assessed VAS at 4 times: during the procedure, at the end of the procedure, and at 3 and 6 hours after the procedure. SPSS 17.0 was used for statistical analysis. RESULTS: The 54 patients were evenly distributed between the 2 study groups. Mean age was 50 years (range 28-71) in the control group, and 54 years (range 27-70) in the experimental group. The mean reduction in VAS values in the experimental group was 27 mm during the procedure, and 23 mm at 6 hours after the procedure. CONCLUSION: Use of a topical lidocaine gel during urethral catheterization results in significant reduction in pain compared to topical lubricants. This benefit is provided both during the procedure as well as up to 6 hours after the procedure.

Management of breast cancer survivors in gynecologic area / 대한산부인과학회지

Incidence of breast cancer and breast cancer survivors has increased in Korea. Breast cancer can affect physical and psychological aspects of cancer survivor by itself and treatment of it. Lots of problems in breast cancer survivors related with gynecological issues, especially in young age. Endometrial and ovarian cancer can occur in breast cancer survivors. It needs to check family history, gynecologic examination, and transvaginal sonography routinely. Young women often experience early menopause as a result of therapy for their breast cancer. Nonpharmacological and pharmacological options can help the survivors with vasomotor symptoms. Osteoporosis can be prevented with calcium and vitamin D supplement, and be treated with drugs such as bisphosphonates. Urogynecologic atrophy distress the survivors, but can be improved with vaginal moisturizer or estrogen. Even though these problems also affect the sexuality of survivors, doctors can help them to cope with it by counseling and medication. As the breast cancer survivors make contact with obstetrics and gynecologic clinic closely, we can improve the quality of life of them ultimately as clinicians.

The Effect of Green Tea on Endothelial Function and the Circulating Endothelial Progenitor Cell in Chronic Smokers

BACKGROUND AND OBJECTIVES: Circulating endothelial progenitor cells (EPC) with an endothelial phenotype contribute to the regeneration and repair of arteries. The number of circulating EPCs has an inverse correlation with chronic smoking and endothelial dysfunction. Green tea cathechin many improve endothelial dysfunction. The effect of green tea cathechin on the number of circulating EPCs and the endothelial dysfunction in chronic smokers is not known. Subjects and METHODS: In 20 young healthy smokers (27.6+/-3.6 years, all male), the endothelial functions that were defined by flow-mediated endothelium dependent vasodilation (FMD) of the brachial artery, as well as the number of EPC isolated from peripheral blood, were determined at baseline and also at 2 weeks after taking green tea (8 g/day). The circulating EPCs were quantified by flow cytometry as CD45low CD34+ KDR2+ cells and as acyl-LDL and FITC-lectin double positive cells after culture for 7 days. RESULTS: The changes of the clinical characteristics and the laboratory findings were not different between baseline and at 2 weeks after green tea intake. The EPC levels were inversely correlated with the number of smoked cigarettes. Circulating EPCs, as determined-by flow cytometry, and the cultured EPCs increased rapidly at 2 weeks after green tea consumption (78.6+/-72.6/mL vs. 156.1+/-135.8/mL, respectively, p<0.001; 118.2+/-35.7/10 field vs. 169.31+/-58.3/10 field, respectively, p<0.001). The FMD was significantly improved after 2 weeks (7.2+/-2.8 vs. 9.3+/-2.4, respectively, p<0.001). The FMD was correlated with the EPC count before treatment (r=0.67, p=0.003) and after 2 weeks (r=0.60, p=0.013). CONCLUSION: The number of circulating EPCs and the FMD are reduced in chronic smokers. Green tea induces rapid improvements of the EPC levels and the FMD. A short-term of consumption of green tea may be effective for reducing the cardiovascular risk in chronic smokers.

The Effects of QRS Duration and Pacing Sites on the Acute Hemodynamic Changes during Right Ventricular Pacing

BACKGROUND: Has been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown. METHODS: A total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized. RESULTS: During RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r=0.500, p=0.001), the change of QRS duration post-pacing (r=0.426, p=0.001), and SBP during sinus rhythm (r=0.342, p=0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing. CONCLUSION: Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.

The Effects of Radiation Using Ho-166 on Endothelial Function in a Porcine Coronary Model

BACKGROUND AND OBJECTIVES: It has been reported that intracoronary radiation therapy (ICRT) using a Ho-166 coated balloon inhibits restenosis of porcine coronary arteries. However, the consequences of ICRT on coronary artery endothelial function are unknown. The aim of this study is to investigate the effects of ICRT using a Ho-166 balloon on coronary artery endothelial function and vasomotor reactivity. MATERIALS AND METHODS: Female pigs (25-35 kg) were orally premedicated daily with aspirin (100 mg) and ticlopidine (250 mg) for the duration of the study. Under sterile conditions with local anesthesia of the skin provided by 2% lidocaine, an arteriotomy of the left carotid artery was performed, an 8 Fr sheath was inserted, and intraarterial heparin sodium (10,000 IU) was injected. Under fluoroscopic guidance, the coronary artery main branch was selected through an 8 Fr guiding catheter for coronary artery overdilation injury (balloon to artery ratio, 1.3:1) and ICRT. A Ho-166 coated balloon prepared to deliver 20 Gy at a depth of 2 mm from the balloon surface was used for ICRT. The coronary artery main branch in each pig was randomly assigned to either balloon injury (Group I) or balloon injury plus ICRT (Group II). Coronary artery segments were taken from the animals at 0 week (n=8), 4 weeks (n=6) and 8 weeks (n=8) after the intervention. Data in each group denote the relative ratio compared to non-injured coronary artery and are expressed as mean +/- standard error of mean. RESULTS: The degree of KCl-induced contractile response (g) was not different between the two groups at 0 and 4 weeks, but was significantly decreased in group II compared to group I at 8 weeks (I:1.04+/-0.06, II:0.79+/-0.07, p=0.014). In rings precontracted with prostaglandin F 2alpha (PGF 2alpha), the degree of NO-dependent relaxation (%) induced with substance P was significantly decreased in group II compared to group I at 0 week (I:0.93+/-0.33, II:0.47+/-0.31, p=0.03), but the difference between the two groups was not significant at 4 and 8 weeks. In rings precontracted with PGF 2alpha and LAME in the presence of indomethacin, the degree of EDHF-induced relaxation (%) using substance P was not different between the two groups at 0, 4 and 8 weeks; nor was the degree of sodium nitroprusside-induced endothelium independent relaxation (%) in depolarized conditions with PGF 2alpha. CONCLUSION: Endothelial function of the porcine coronary artery is only transiently impaired after ICRT using a Ho-166 coated balloon. Therefore this therapy can be used as an effective method to prevent restenosis after percutaneous coronary intervention.

Phase II Study of FAC(5-FU/Interferon- a/CBDCA) as Neoadjuvant Chemotherapy in Patients with Locally Advanced and/or Bulky / 대한부인종양콜포스코피학회잡지

Interferon(IFN) has been noted to augment the cytotoxicity of cisplatin analogues and S-FU, and varying degrees of success were reported when combined with chemotherapy in a number of squamous cell carcinomas. The aims of this study were to assess its therapeutic efficacy and to establish the feasibility and toxicity of biochemical modulation of the interferon-a-2a when combined with 5-FU and carboplatin(CBDCA) in locally advanced(> or =FIGO clinical stage IJb) and/or bulky(largest diameter > or = 3cm) cervical cancer. From January 1995 to December 1996, 20 patients with bulky and/or locally advanced cervical cancer were enrolled in this study and received FAC(5-FU/Interferon-a/CBDCA) combination chemotherapy as a neoadjuvant setting. The FAC regimen was composed of IFN- a -2a 3x10(6) IU/day from day l to day 6, 5-FU 750mg/m2/day from day 2 to day 6, and carboplatin at a dose calculated by Calvert formula with AUC(area under the curve) 6.0 on day 2. Three cycles of neoadjuvant chemotherapy was performed with 3 weeks interval if toxicity permitted it. Patients were examined after every treatment cycle and evaluated for toxicities and responses using standard GOG criteria. Two patients(10.0%) showed complete clinical response and 15 patients(75,0%) had partial response. The other patients had stable(10.0%) or progressive disease(5.0%). Among fifteen patients who have undergone radical hysterectomy, pathological complete response was not noted. Surgery was possible in 15 patients(75.0%) and 10 patients received adjuvant radiotherapy. Lymph node metastases were found in 5 patients(33.3%) and the number of positive nodes was ranged from 1 to 5. The most frequent grade 3 or 4 toxicity was neutropenia(60.0%) followed by alopecia(40.0%), nausea/vomiting(35.0%), thrombocytopenia(15.0%), diarrhea(5.0%), and anemia(5.0%). (continue)