Difference in Clinical Features between Right- and Left-Sided Acute Colonic Diverticulitis.

Right colonic diverticulitis (RCD) and left colonic diverticulitis (LCD) may have different clinical features due to the different embryologic origins and anatomical locations of each colon. Therefore, we aimed to compare RCD and LCD in terms of the associated clinical features. We retrospectively collected clinical data from patients who were diagnosed with acute colonic diverticulitis based on computed tomography findings between 2011 and 2017. RCD was defined as colonic diverticulitis extending from the caecum to the transverse colon, and LCD was defined as extending from the splenic flexure to the sigmoid colon. These analyses included 667 patients with RCD and 58 patients with LCD. Relative to the patients with LCD, the patients with RCD were younger (P < 0.001), were more likely to be male (P = 0.033), were taller (P < 0.001), had lower body mass index values (P < 0.001), had less advanced modified Hinchey stages (P < 0.001), and had shorter hospital stays (P < 0.001). Having LCD rather than RCD was a predictor of recurrent colonic diverticulitis (P = 0.003). Relative to LCD, RCD occurs at younger ages, is expressed at less advanced modified Hinchey stages, and is associated with lower risks of recurrence.

Inflammatory Myofibroblastic Tumor of the Retroperitoneum Including Chronic Granulomatous Inflammation Suggesting Tuberculosis: A Case Report.

An inflammatory myofibroblastic tumor (IMT) is a solid tumor of unknown etiology frequently affecting children and young adults and commonly affecting the lung or orbital region. We present a case involving a 41-year-old man who had an IMT combined with Mycobacterium tuberculosis infection in the retroperitoneum. He presented with only pain in the right lower abdomen without accompanying symptoms; a retroperitoneal mass was found on computed tomography. The tumor had invaded the end of the ileum and was attached to the omentum, so mass excision could not be performed. The tumor was completely excised surgically and had histological features diagnostic of an IMT. Histologic findings of the omentum were positive for Ziehl-Nielsen staining for acid-fast bacilli and for a positive polymerase chain reaction for M. tuberculosis. The patient had no apparent immune disorder. These findings made this case exceptional because IMTs, which are mostly due to atypical mycobacteria, have been found mainly in immunocompromised patients.

Reduced Tacrolimus Trough Level Is Reflected by Estimated Glomerular Filtration Rate (eGFR) Changes in Stable Renal Transplantation Recipients: Results of the OPTIMUM Phase 3 Randomized Controlled Study.

BACKGROUND Minimizing the tacrolimus dosage in patients with stable allograft function needs further investigation. MATERIAL AND METHODS We performed an open-label, randomized, controlled study from 2010 to 2016 in 7 tertiary teaching hospitals in Korea and enrolled 345 kidney transplant recipients with a stable graft status. The study group received reduced-dose tacrolimus, 1080-1440 mg/day of enteric-coated mycophenolate sodium (EC-MPS), and corticosteroids. The control group received the standard tacrolimus dosage and 540-720 mg/day of EC-MPS with steroids. The primary endpoint was the mean estimated glomerular filtration rate (eGFR) and change in the eGFR at 12 months after randomization. RESULTS The mean tacrolimus trough level of the study group was 4.51±1.62 ng/mL, which was lower than that of the control group, at 6.75±2.82 ng/mL (P<0.001). The primary endpoint was better in the study group in terms of change in eGFR (P<0.001). The month 12 eGFRs were 73.6±28.4 and 68.3±18.1 mL/min/1.73 m² in the study and the control groups, respectively, but the difference did not reach statistical significance (P=0.07). The incidence of adverse events was similar between the study and the control groups. CONCLUSIONS Minimizing tacrolimus to a trough level below 5 ng/mL combined with conventional EC-MPS can be considered in patients with a steady follow-up, as it was associated with small benefits in the changes of the eGFR (Clinicaltrials.gov number: NCT01159080).

Physicochemical interactions of cycloamylose with phenolic compounds.

The complex formation capability of cycloamylose (CA), having a degree of polymerization of 23-45, with phenolic compounds (PCs) was investigated using various physicochemical techniques. The fluorescence intensity of PCs increased and then reached a plateau at 10-20mM cyclodextrin, while it continued to increase at up to 60mM CA. Thermodynamic data of CA complexes with PCs revealed that the binding process was primarily enthalpy-driven and spontaneous. CA favored to form the most stable complex with chlorogenic acid (CHA) among all PCs. Chemical shift changes for the protons in interior and exterior of CA, as well as in PCs suggested a possible formation of both inclusion and extramolecular interactions between CA and PCs. The ROESY spectrum confirmed that the aromatic moieties of CHA were partially interacted with CA molecules through relatively weak binding. XRD, DSC, and SEM results also supported the complex formation by intermolecular interaction between CA and CHA.

Inhibitory effect of sustained perivascular delivery of paclitaxel on neointimal hyperplasia in the jugular vein after open cutdown central venous catheter placement in rats.

PURPOSE: Inhibitory effect of paclitaxel on neointimal hyperplasia after open cutdown has not been elucidated. METHODS: For the control group (n = 16), silicone 2.7-Fr catheters were placed via the right external jugular vein with the cutdown method. For the treatment group (n = 16), a mixture of 0.65 mg of paclitaxel and 1 mL of fibrin glue was infiltrated around the exposed vein after cutdown. After scheduled intervals (1, 2, 4, and 8 weeks), the vein segment was harvested and morphometric analysis was performed on cross-sections. RESULTS: Proliferation of smooth muscle cell (SMC) was strongly suppressed in the treatment group, and the ratio of neointima to vein wall was significantly reduced in the treatment group (8 weeks; 0.63 ± 0.08 vs. 0.2 ± 0.08, P < 0.05). Luminal patency was significantly more preserved in the treatment group, and the luminal area was significantly wider in the paclitaxel-treated group compared to the control group (8 weeks; 1.91 ± 0.43 mm2 vs. 5.1 ± 0.43 mm2, P < 0.05). Mean SMC counts measured at 1 and 2 weeks after cutdown were significantly lower in the treatment group (2 weeks; 115 ± 22 vs. 62 ± 22). Paclitaxel was undetectable in systemic circulation (<10 ng/mL). CONCLUSION: Sustained perivascular delivery of paclitaxel with fibrin glue was effective in inhibiting neointimal hyperplasia in rat jugular vein after open cutdown.

Predictors of Positive CT Yield in Pediatric Patients With Nontraumatic Abdominal Pain.

OBJECTIVE: The use of abdominal computed tomography (ACT) for nontraumatic abdominal pain in the pediatric emergency department is increasing to a remarkable extent, and every effort should be made to select patients who would benefit from ACT. The aim of this study was to investigate the clinical and laboratory predictors of positive CT yield in pediatric patients with nontraumatic abdominal pain. METHODS: The medical records of 739 pediatric patients who, between January 2009 and February 2014, underwent ACT for nontraumatic abdominal pain at the emergency department were reviewed retrospectively. These patients were divided into 2 groups: a right lower quadrant (RLQ) pain group and a non-RLQ pain group. The radiology reports were reviewed to determine ACT diagnoses. Univariate and multivariate analysis was performed to elicit independent predictors of positive ACT yield. Equations predicting the probability of positive ACT diagnosis were deduced from the regression equation in both groups. RESULTS: In the RLQ pain group, the most frequent ACT diagnosis was acute appendicitis, and in the non-RLQ pain group, enteritis was the most frequent diagnosis. In the RLQ pain group, sex, leukocytosis, neutrophil-to-lymphocyte ratio, and elevated C-reactive protein were significant independent predictors for positive ACT diagnosis. The number of synchronous predictor was significantly related to the proportion of positive ACT diagnosis. In the non-RLQ pain group, leukocytosis was the only significant predictor in multivariate analysis. CONCLUSIONS: Factors predicting positive CT yield were sex, leukocytosis, neutrophil-to-lymphocyte ratio, and elevated C-reactive protein in the RLQ pain group and leukocytosis in the non-RLQ pain group.

Novel formulation of low-fat spread using rice starch modified by 4-α-glucanotransferase.

Low-fat spreads were developed using a thermoreversible gelling agent, the 4-α-glucanotransferase (4αGT)-modified rice starch. The low-fat spreads consisted of the modified starch paste (or rice starch or maltodextrin), olive oil (0-30% w/w), egg yolk, salt, xanthan gum, and butter flavor, and were produced by homogenization, ultrasonic processing at 50% amplitude for 2min, and cold-gel setting at 4°C for 24h. Formulations with 15% and 20% of the modified starch paste resulted in highly stable oil-in-water low-fat spreads having varied textural properties and acceptable spreadability, whereas formulations with rice starch and maltodextrin did not yield enough stability and consistency. Moreover, the modified starch-based low-fat spreads showed high thermoreversibility. These results indicated that 4αGT-modified starch could be used in the preparation of low-fat spreads, allowing the formulation of functional products for healthy diets.

Pediatric appendectomy: the outcome differences between pediatric surgeons and general surgeons.

PURPOSE: The aim of this study was to review our experience of pediatric appendectomy performed by either a general surgeon (GS) or a pediatric surgeon (PS) to determine any differences in outcomes. METHODS: We reviewed the medical records of pediatric appendicitis patients, 4 years before (GS group, 2007-2010) and after (PS group, 2011-2014) the introduction of a pediatric surgical practice. The records were reviewed for the following variables: operation time, length of hospital stay, complications, readmission in ≤30 days, type of operation, negative for appendicitis, drainage, open conversion, and reoperation in ≤30 days. RESULTS: Over 8 years, 400 patients were operated on for acute appendicitis, with the PS group comprising 61 % (N = 244) of patients. The operation time (55.1 vs 43.2 min, p = 0.0001) and postoperative length of hospital stay (3.5 vs 2.7 days, p = 0.001) were shorter, more patients were treated by laparoscopy (61.3 vs 91.2 %, p = 0.0001), and a fewer patients required peritoneal drainage (29.5 vs 63.2 %, p = 0.023) in the PS group than in the GS group. The negative appendectomy rate was slightly lower in the PS group, but not to a statistically significant degree. CONCLUSION: The patients in the PS group enjoyed a reduced operation time and length of hospital stay, greater likelihood of laparoscopic operation, and less peritoneal drainage than the patients in the GS group.

Incidental detection of a small solid pseudopapillary neoplasm of the pancreas after a traffic accident in a 12-year-old girl: a case report.

Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas that tends to grow silently in patients at a young age, to a large size and mass. We report here a case of a small-sized SPN detected incidentally in a 12-year-old girl following a traffic accident. The tumor was 3.5 cm in maximal diameter and was found to have hemorrhagic necrosis without a solid component. Laparoscopic spleen-preserving distal pancreatectomy was performed which cured the patient. SPN is generally accepted to be a low grade malignant tumor, but its clinical behavior is sometimes unpredictable. Tumor size and the proportion of solid portion of the tumor have both recently been identified as predictors of malignancy. Although the initial presentation in this case was that of the traffic accident, the subsequent detection of a small, totally cystic SPN, and then the complete eradication of the lesion, led to a favorable outcome for the patient. Long-term monitoring should prevent any chance of recurrence.

Histological changes of the unligated vein wall adjacent to the central venous catheter after open cutdown in rats.

BACKGROUND: The sequelae of a central venous cutdown usually include venous deformity causing venous stenosis or stricture. However, the cellular mechanisms causing these deformities have not been elucidated. METHODS: Silicone 2.7-Fr catheters were placed via the right external jugular vein of 16 rats with the cutdown method. After fixation with formalin at scheduled intervals (1week, 2weeks, 4weeks, and 8weeks; 4 rats in each group), the vein segment with the catheter in situ was harvested. Histological changes in the vein wall were studied and serially compared with light microscopy; standard hematoxylin-eosin staining, Masson's trichrome staining, van Gieson's elastin stain, and immunohistochemical stain against α-actin. RESULTS: Pericatheter sleeve formation, circumferential smooth muscle cell proliferation and infiltration into the pericatheter sleeve by direct contact were noted in all 4 rats of 1-week model; this indicated the initiation of neointimal hyperplasia. The neointimal hyperplasia was located inside the elastin layer. At 2weeks, the SMCs stained faintly but the components of the vein wall were largely replaced by collagen. The proliferation and infiltration of SMCs stabilized at 4weeks and no SMCs were stained around the catheter. At 8weeks, luminal narrowing was noted and the venous wall was composed mainly of collagen. CONCLUSIONS: Circumferential neointimal hyperplasia occurred after surgical cutdown of the external jugular vein in a rat model and was caused by SMC activation, proliferation, and infiltration into the pericatheter sleeve.

Increasing utilization of abdominal CT in the Emergency Department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients?

PURPOSE: The use of abdominal computed tomography (ACT) utilization is increasing to a remarkable extent in the pediatric Emergency Department (ED), but the clinical benefit of increased use of ACT for pediatric surgical patients remains uncertain. METHODS: A retrospective review was conducted to investigate if, for patients who had visited pediatric ED during the last 5 years, increasing utilization of ACT would increase the detection rate of acute appendicitis, increase the detection rate of surgical conditions other than appendicitis, and decrease the hospital admission rate for surgical conditions. RESULTS: During the study period, there were 37,918 ED visits; of these, 3,274 (8.6%) were for abdominal pain, 844 (2.2%) had ACT performed. The annual proportional increase of the ACT was statistically significant (1.56% to 2.46%, P = 0.00), but the detection rate of acute appendicitis (3.3% to 5.1%) or other surgical conditions (1.7% to 2.8%) showed no statistically significant changes. Hospital admission rates (5.6% to 6.8%) also showed no significant changes during the study period. CONCLUSION: Increasing utilization of ACT does not lead to the improved outcomes in caring for pediatric surgical patients visiting the pediatric ED. Careful evaluation for the indication for ACT is needed in the pediatric ED.

Physicochemical functionality of 4-α-glucanotransferase-treated rice flour in food application.

The physicochemical properties of 4-α-glucanotransferase (4αGTase)-modified rice flours were examined by measuring the molecular weight distribution, moisture sorption isotherm, and melting enthalpy of ice crystals. The results obtained by measuring the moisture sorption isotherm and melting enthalpy of ice crystals revealed that 4αGTase-modified rice flours had high water binding capacity than that of control rice flour. When the textural properties of noodles containing 4αGTase-treated rice flours after freeze-thaw cycling were measured by texture profile analysis, the textural properties of control noodle deteriorated. However, those of noodle with 4αGTase-modified rice flours were retained. For the melting enthalpy of ice crystals formed within cooked noodles, 4αGTase-treated rice flour showed similar effect to sucrose for reducing the melting enthalpy of ice crystals, however, the texture and taste of noodle with sucrose was undesirable for consuming. 4αGTase-treated rice flour appeared to have good potential as a non-sweet cryoprotectant of frozen product.

Development of reduced-fat mayonnaise using 4alphaGTase-modified rice starch and xanthan gum.

In this study a disproportionating enzyme, 4-alpha-glucanotransferase (4alphaGTase), was used to modify the structural properties of rice starch to produce a suitable fat substitute in reduced-fat (RF) mayonnaise. The mayonnaise fat was partially substituted with the 4alphaGTase-treated starch paste at levels up to 50% in combination with xanthan gum and the physical and rheological properties of the modified RF mayonnaise samples were investigated. All mayonnaises prepared in this study exhibited shear thinning behavior and yield stress. Viscoelastic properties of mayonnaise were characterized using dynamic oscillatory shear test and it was observed that mayonnaises exhibited weak gel-like properties. The magnitude of elastic and loss moduli was also affected by 4alphaGTase-treated starch concentration and presence of xanthan gum. In relation to microstructure, RF mayonnaise prepared with 3.8 or 5.6 wt% of 4alphaGTase-treated starch and xanthan gum showed smaller droplets. The use of 5.6 wt% of 4alphaGTase-treated starch and 0.1 wt% of xanthan gum produced a RF mayonnaise with similar rheological properties and appearances as FF mayonnaise with gum. This study demonstrated a high feasibility for using 4alphaGTase-treated rice starch as a viable fat replacer in mayonnaise.

Molecular epidemiology of community-associated antimicrobial-resistant Staphylococcus aureus in Seoul, Korea (2003): pervasiveness of multidrug-resistant SCCmec type II methicillin-resistant S. aureus.

There is an extremely high incidence of antimicrobial resistance of the clinical isolates of Staphylococcus aureus in Korea. This study carried out a molecular investigation to determine the prevalence of the community-associated antimicrobial-resistant S. aureus and methicillin-resistant S. aureus (MRSA). The percentage resistance from the nasal swabs of healthy volunteers in 2003 in Seoul is as follows: penicillin (91%), erythromycin (EM, 14%), gentamicin (GM, 9.3%), tetracycline (TE, 8.2%), cephalothin (4%), oxacillin (OX, MRSA; 3.8%), clindamycin (CC, 2.6%), ciprofloxacin (CIP, 0.8%), and sulfamethoxazole/trimethoprim (0.6%). The community-associated MRSA (C-MRSA) strains were examined by pulsed-field gel electrophoresis (PFGE) analysis of the SmaI macro-fragments, multilocus sequence typing (MLST), and staphylococcal cassette chromosome mec (SCCmec) typing using the PCR analysis. The Korean C-MRSA isolates were clustered into three distinct groups. One PFGE group containing the C-MRSA strains showed resistance to CC, EM, and GM, a high level (32-96 microg/ml) of resistance to methicillin, sequence type 5 (ST5), and SCCmec type II, which is the most common hospital associated-MRSA (H-MRSA) isolated in Korea. These results highlight the heterogeneous genetic background of the C-MRSA as well as the pervasiveness of the H-MRSA isolates in this community.

Evaluation of viral clearance in the production of HPV-16 L1 virus-like particles purified from insect cell cultures.

Biopharmaceutical products produced from cell cultures have a potential for viral contamination from cell sources or from adventitious introduction during production. The objective of this study was to assess viral clearance in the production of insect cell-derived recombinant human papillomavirus (HPV)-16 type L1 virus-like particles (VLPs). We selected Japanese encephalitis virus (JEV), bovine viral diarrhea virus (BVDV), and minute virus of mice (MVM) as relevant viruses to achieve the aim of this study. A downstream process for the production of purified HPV-16 L1 VLPs consisted of detergent lysis of harvested cells, sonication, sucrose cushion centrifugation, and cesium chloride (CsCl) equilibrium density centrifugation. The capacity of each purification/treatment step to clear viruses was expressed as reduction factor by measuring the difference in log virus infectivity of sample pools before and after each process. As a result, detergent treatment (0.5% v/v, Nonidet P-40/phosphate-buffered saline) was effective for inactivating enveloped viruses such as JEV and BVDV, but no significant reduction (< 1.0 log(10)) was observed in the non-enveloped MVM. The CsCl equilibrium density centrifugation was fairly effective for separating all three relevant adventitious viruses with different CsCl buoyant density from that of HPV-16 L1 VLPs (JEV, BVDV, and MVM = 4.30, 3.10, > or = 4.40 log(10) reductions). Given the study conditions we used, overall cumulative reduction factors for clearance of JEV, BVDV, and MVM were > or = 10.50, > or = 9.20, and > or = 6.40 log(10) in 150 ml of starting cell cultures, respectively.

Development of real-time RT-PCR for evaluation of JEV clearance during purification of HPV type 16 L1 virus-like particles.

Insect cell culture has greatly increased in part due to the widespread use of insect virus-based vectors for efficient expression of foreign proteins. Insect cells such as Sf9 cells are susceptible to arboviruses which may pose a safety concern by adventitious introduction during the production process. The objective of this study was to establish techniques for viral clearance validation of insect cell-derived biotechnological products using Japanese encephalitis virus (JEV) as a model, since JEV is a member of arthropod-borne flaviviruses that are known to be infectious in insect cells. Here we report the development of a quantitative assay for JEV RNA using real-time reverse transcription-polymerase chain reaction (RT-PCR). The assay was performed using LightCycler and RNA amplification kit SYBR Green I. The JEV specific primer was selected from the 3' untranslated region, and the expected band size was 323 base pairs (bp). The sensitivity of the assay was calculated to be approximately 15 TCID(50)per reaction. Highly reproducible standard curves were obtained from experiments performed on three different days. JEV clearance was determined during the purification process of rHPV-16 L1 VLPs by CsCl equilibrium density centrifugation. The comparative results obtained by real-time RT-PCR assay for JEV and infectivity titrations suggested that the real-time RT-PCR assay could have an additive effect on the interpretation and evaluation of virus clearance, especially during the virus removal process.