Fractional Radiofrequency Microneedling Combined With Fractional Carbon Dioxide Laser Treatment for Striae Distensae.

BACKGROUND AND OBJECTIVES: To evaluate the safety and effectiveness of combined fractional radiofrequency microneedling (FRM) and fractional carbon dioxide (FCO2 ) laser treatment for striae distensae and to compare the results to those of FRM alone and those of FCO2 alone. STUDY DESIGN/MATERIALS AND METHODS: Adult women (Fitzpatrick skin types III-IV) with striae distensae on the abdomen or calf were enrolled in this study. Each lesion was divided into three regions, with each region assigned to one of the three treatments (FCO2 , FRM, or combined FCO2 and FRM). Global photographic assessments were performed by three dermatologists and by patients using a scored visual analog scale (VAS). Additionally, each lesion was evaluated using a skin imaging analyzer and a diagnostic ultrasound system. RESULTS: All 19 female subjects had an average body mass index of 23.85 kg/m2 . The global assessment by dermatologists indicated a significant improvement in the combined treatment group (6.1) compared with the other groups (4.3 and 5.1 in the FRM and FCO2 groups, respectively; P < 0.05), and that by the patients indicated a significant improvement in the combined treatment group (6.3) compared with the FRM group (5.1; P = 0.02). Ultrasound results showed significantly increased skin thickness and dermal density (204.9 µm and 8.8%; both P < 0.05) in the combined treatment group. However, results of the skin imaging analysis showed a higher average level of melanin and redness indices in the combined treatment group than in the FRM group (P < 0.001, P < 0.01, respectively), but not in the FCO2 group (P = 0.15, P = 0.11, respectively). CONCLUSION: Combined FRM and FCO2 treatments resulted in slightly better clinical outcomes than single treatments, and the side effects of the treatment, such as pigmentation and persistent erythema, did not result in more serious events to a level similar to that of FCO2 alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

BATF regulates innate lymphoid cell hematopoiesis and homeostasis.

Early hematopoietic progenitors undergo sophisticated developmental processes to become committed innate lymphoid cell (ILC) progenitors and ultimately mature ILC subsets in the periphery. Basic leucine zipper ATF-like transcription factor (Batf) plays important roles in lymphocyte biology. We report here that Batf regulates the production of bone marrow ILC progenitors and maintenance of peripheral ILCs. The expression of Batf is induced during ILC development at the α-lymphoid progenitor stage in response to the cytokine IL-7. As a potential mechanism, up-regulated Batf binds and activates transcription of the Nfil3 gene to promote ILC hematopoiesis. Batf is necessary to maintain normal numbers of early and late ILC progenitors in the bone marrow and mature ILC1, ILC2, ILC3, and NK cells in most peripheral tissues. Batf deficiency causes ILC lymphopenia, leading to defective ILC responses to inflammatory cytokines and defective immunity to enteric bacterial infections. Thus, Batf plays critical roles in bone marrow hematopoiesis, peripheral homeostasis, and effector functions of ILCs.

Genetic diversity of ORF 4-6 of type 1 porcine reproductive and respiratory syndrome virus in naturally infected pigs.

Genotype 1 porcine reproductive and respiratory syndrome virus (PRRSV) has been highly prevalent throughout Korea since the virus was first detected in 2005. However, genetic analyses of genotype 1 PRRSV in Korea have been limited to ORF5 and/or ORF7. In the present study, we determined 10 representative sequence covering ORF4 to ORF6 and each individual ORFs of genotype 1 PRRSV in Korea, and performed molecular analyses. The most variable gene among the individual ORFs of field strains was ORF4, and this gene exhibited only 74.5-87.3% sequence homology compared with strains reported elsewhere. However, the strains showed analogous sequence arrangements with each other. In the phylogenetic analysis, the sequences of Korean field strains formed a distinct cluster with some Austrian and German strains compared to genotype 1 PRRSV strains available in GenBank. In the amino acid analysis, the putative antigenic region of GP4 was highly variable, whereas the predicted epitope regions of ORF5 and ORF6 were relatively conserved. The hydropathy plots of GP4 showed a highly variable pattern in the antigenic region. The non-synonymous and synonymous substitution analysis suggested that ORF4 presumably had more immunogenic pressure compare with the other ORFs. According to these findings, genotype 1 PRRSV in Korea has been diversified and indigenized in Korea, and these strains might have multifarious immunological and genetic properties. This study provides novel insights into genotype 1 PRRSV in a geographically remote area and contributes to the information for further research on the evolution of type 1 PRRSV in the Korean peninsula.

Retinoic Acid Differentially Regulates the Migration of Innate Lymphoid Cell Subsets to the Gut.

Distinct groups of innate lymphoid cells (ILCs) such as ILC1, ILC2, and ILC3 populate the intestine, but how these ILCs develop tissue tropism for this organ is unclear. We report that prior to migration to the intestine ILCs first undergo a "switch" in their expression of homing receptors from lymphoid to gut homing receptors. This process is regulated by mucosal dendritic cells and the gut-specific tissue factor retinoic acid (RA). This change in homing receptors is required for long-term population and effector function of ILCs in the intestine. Only ILC1 and ILC3, but not ILC2, undergo the RA-dependent homing receptor switch in gut-associated lymphoid tissues. In contrast, ILC2 acquire gut homing receptors in a largely RA-independent manner during their development in the bone marrow and can migrate directly to the intestine. Thus, distinct programs regulate the migration of ILC subsets to the intestine for regulation of innate immunity.

Th9 cell development requires a BATF-regulated transcriptional network.

T helper 9 (Th9) cells are specialized for the production of IL-9, promote allergic inflammation in mice, and are associated with allergic disease in humans. It has not been determined whether Th9 cells express a characteristic transcriptional signature. In this study, we performed microarray analysis to identify genes enriched in Th9 cells compared with other Th subsets. This analysis defined a transcriptional regulatory network required for the expression of a subset of Th9-enriched genes. The activator protein 1 (AP1) family transcription factor BATF (B cell, activating transcription factor­like) was among the genes enriched in Th9 cells and was required for the expression of IL-9 and other Th9-associated genes in both human and mouse T cells. The expression of BATF was increased in Th9 cultures derived from atopic infants compared with Th9 cultures from control infants. T cells deficient in BATF expression had a diminished capacity to promote allergic inflammation compared with wild-type controls. Moreover, mouse Th9 cells ectopically expressing BATF were more efficient at promoting allergic inflammation than control transduced cells. These data indicate that BATF is a central regulator of the Th9 phenotype and contributes to the development of allergic inflammation.

Short-chain fatty acids activate GPR41 and GPR43 on intestinal epithelial cells to promote inflammatory responses in mice.

BACKGROUND & AIMS: Short-chain fatty acids (SCFAs), the most abundant microbial metabolites in the intestine, activate cells via G-protein-coupled receptors (GPRs), such as GPR41 and GPR43. We studied regulation of the immune response by SCFAs and their receptors in the intestines of mice. METHODS: Inflammatory responses were induced in GPR41(-/-), GPR43(-/-), and C57BL6 (control) mice by administration of ethanol; 2, 4, 6-trinitrobenzene sulfonic-acid (TNBS); or infection with Citrobacter rodentium. We examined the effects of C rodentium infection on control mice fed SCFAs and/or given injections of antibodies that delay the immune response. We also studied the kinetics of cytokine and chemokine production, leukocyte recruitment, intestinal permeability, and T-cell responses. Primary colon epithelial cells were isolated from GPR41(-/-), GPR43(-/-), and control mice; signaling pathways regulated by SCFAs were identified using immunohistochemical, enzyme-linked immunosorbent assay, and flow cytometry analyses. RESULTS: GPR41(-/-) and GPR43(-/-) mice had reduced inflammatory responses after administration of ethanol or TNBS compared with control mice, and had a slower immune response against C rodentium infection, clearing the bacteria more slowly. SCFAs activated intestinal epithelial cells to produce chemokines and cytokines in culture and mice after administration of ethanol, TNBS, or C rodentium. These processes required GPR41 and GPR43 and were required to recruit leukocytes and activate effector T cells in the intestine. GPR41 and GPR43 activated extracellular signal-regulated kinase 1/2 and p38 mitogen-activated protein kinase signaling pathways in epithelial cells to induce production of chemokines and cytokines during immune responses. CONCLUSIONS: SCFAs activate GPR41 and GPR43 on intestinal epithelial cells, leading to mitogen-activated protein kinase signaling and rapid production of chemokines and cytokines. These pathways mediate protective immunity and tissue inflammation in mice.

Retinoic acid promotes the development of Arg1-expressing dendritic cells for the regulation of T-cell differentiation.

Arginase I (Arg1), an enzyme expressed by many cell types including myeloid cells, can regulate immune responses. Expression of Arg1 in myeloid cells is regulated by a number of cytokines and tissue factors that influence cell development and activation. Retinoic acid, produced from vitamin A, regulates the homing and differentiation of lymphocytes and plays important roles in the regulation of immunity and immune tolerance. We report here that optimal expression of Arg1 in DCs requires retinoic acid. Induction of Arg1 by retinoic acid is directly mediated by retinoic acid-responsive elements in the 5' noncoding region of the Arg1 gene. Arg1, produced by DCs in response to retinoic acid, promotes the generation of FoxP3(+) regulatory T (Treg) cells. Importantly, blocking the retinoic acid receptor makes DCs hypo-responsive to known inducers of Arg1 such as IL-4 and GM-CSF in Arg1 expression. We found that intestinal CD103(+) DCs that are known to produce retinoic acid highly express Arg1. Our results establish retinoic acid as a key signal in expression of Arg1 in DCs.

Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience.

BACKGROUND: Few reports describe the use of laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) in centers with experience using this technique. In addition, the clinical outcomes of this procedure remain undetermined. METHODS: In the current study, 100 patients with benign or malignant lesions in the pancreatic head underwent LPPPD between May 2007 and December 2011. The overall clinical outcomes and changes in these outcomes during the surgeon learning period were analyzed to assess the feasibility and safety of this procedure. RESULTS: Pathologic examination of the pancreas confirmed intraductal papillary mucinous neoplasms in 37 patients, solid pseudopapillary tumors in 17 patients, neuroendocrine tumors in 15 patients, serous cystic neoplasms in seven patients, pancreatic ductal adenocarcinomas in seven patients, ampulla of Vater tumors and duodenal gastrointestinal stromal tumors in five patients, and other disease in seven patients. The median operative time was 7.9 h, which decreased with accumulating experience of the surgeon using this procedure, from 9.8 h for the first 33 cases to 6.6 h for the last 34 cases. Complications developed in 25% of the patients, including six cases (6%) with significant pancreatic fistula [International Study Group on Pancreatic Fistula (ISGPF) grade B]. The complication rate decreased from 33.3% for the first 33 cases to 17.6% for the last 34 cases. The mean hospital stay was 14 days, which also decreased from 20.4 days for the first 33 cases to 11.5 days for the last 34 cases. For the 12 patients in the study cohort with invasive malignant disease, the median tumor size was 2.8 cm, and the median number of lymph nodes harvested was 13. All the patients had margin-negative R0 resections. CONCLUSION: The LPPPD procedure is technically safe and feasible, with an acceptable rate of morbidity and other clinical outcomes for benign and malignant diseases. Clinical outcomes can be improved once a learning curve has been overcome.

Effects of fermented soybean meal on growth performance, diarrheal incidence and immune-response of neonatal calves.

The effects of partial substitution of fermented soybean meal (FSBM) for soybean meal (SBM) on immune-physiological parameters, growth performance and diarrheal incidence in neonatal calves after microbial infection were investigated. Holstein calves (n = 12) were randomly assigned to two dietary treatments: the SBM and the FSBM group. The latter group received a calf starter containing 5% FSBM instead of SBM. In order to evaluate the immunocompetence against microbial infection, all calves were challenged with porcine live vaccine by intramuscular injection at 21 days of age. The incidence and severity of diarrhea were significantly less (P < 0.05) in the FSBM group compared to those in the SBM group at 21 and 42 days of age. Feeding FSBM starter resulted in a higher (P < 0.05) relative amount of bacterial-specific IgA than those on SBM at days 5 and 14 post-microbial infection (DPMI). Viral-specific IgA also increased (P < 0.05) at 5 DPMI in the FSBM group when compared to the SBM group. The average concentration of haptoglobin of calves fed FSBM was generally higher at 3 DPMI. Our results indicate that FSBM plays a role in the alleviation of diarrhea and in the production of immune-related effector cells such as IgA and haptoglobin in calves.

Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution.

BACKGROUND: Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic distal pancreatic resection (LDPR) with open distal pancreatic resection (ODPR). This study aimed to compare clinical outcomes for LDPR and ODPR performed at a single institution. METHODS: For this study, 93 patients with benign pancreatic disease underwent LDPR, and 35 patients with benign pancreatic disease underwent ODPR. Patient demographic characteristics, operative times, perioperative complications, length of hospital stay, and return to normal diet were compared retrospectively between the two groups. RESULTS: The LDPR and ODPR groups had the same demographic characteristics. The median operative time was 195 min in the LDPR group and 190 min in the ODPR group (p>0.05). The rate of spleen preservation was higher in the LDPR group (40.8%) than in the ODPR group (5.7%) (p<0.05) No operative mortality occurred in either group. The overall complication rate was 24.7% in the LDPR group and 29% in the ODPR group (p>0.05). The rate of pancreas-related complications was 11.8% in the LDPR group and 17.2% in the ODPR group (p>0.05). Pancreatic fistula developed in 8.6% of the LDPR group and in 14.3% of the ODPR group (p>0.05). Bowel movement return to normal and resumption of normal diet were achieved 2.8+/-1.3 days after the operation in the LDPR group and 4.5+/-1.6 days after the operation in the ODPR group (p<0.05). The median duration of hospital stay was 10 days for the LDPR group, which was significantly shorter than the 16 days for the ODPR group (p<0.01). CONCLUSION: The use of LDPR for benign lesions of the distal pancreas is feasible and safe. The LDPR procedure is associated with operative times and complication rates similar to those for ODPR, but LDPR has the advantages of an earlier return to normal bowel movements and normal diet and shorter hospital stays than ODPR.

Intraductal papillary mucinous neoplasm of the pancreas: clinical characteristics and treatment outcomes of 118 consecutive patients from a single center.

BACKGROUND/PURPOSE: Appropriate surgical treatment strategies based on clinicopathological findings are unavailable for intraductal papillary mucinous neoplasm (IPMN) of the pancreas. We investigated the clinical features of pancreatic IPMN in a single-center database in order to design an optimal surgical strategy. METHODS: The medical records of 118 consecutive patients who had undergone surgical resection between August 1994 and December 2004, in whom IPMN was histologically confirmed, were reviewed retrospectively for radiological and pathological findings. RESULTS: Most of the invasive carcinomas in these patients were detected as the main-duct type (88.5%). The type of tumor (main-duct type vs branched-duct type), the tumor size, and the dilated duct size were significant predictive factors associated with malignancy. The relative risk of malignancy was greatest at 13-mm or more ductal dilation in the main-duct type (Odds ratio, 4.1), at 35-mm or more tumor size (Odds ratio, 7.6), and for main-duct type (Odds ratio, 3.9). Major pancreatic resections such as total pancreatectomy and pancreatoduodenectomy were performed in 14.5% and 69% of the patients, respectively. There was a 19.5% rate of incomplete resection, with these patients having a positive resection margin. However, significant recurrence did not occur in patients with a benign IPMN lesion which remained at the resection margin. The overall postoperative survival rate at 5 years was 98.2% for benign IPMN and 65.3% for malignant IPMN. CONCLUSIONS: Function-preserving strategies, based on the clinical status of the patient, are necessary in order to avoid possible severe metabolic complications following extended pancreatectomy in patients with benign IPMN because of the low recurrence rate and good prognosis of this entity, irrespective of margin status.

Effect of resistant starch from corn or rice on glucose control, colonic events, and blood lipid concentrations in streptozotocin-induced diabetic rats.

To examine the effect of two types of resistant starch on blood glucose and insulin levels, colonic events, hypolipidemic actions and humoral immune responses, Sprague-Dawley streptozotocin-induced diabetic rats were fed diet containing resistant starch from corn or rice. The marked body weight loss by inducing diabetes was not recovered by feeding resistant starch, even though there are no differences in food intakes compared to the non-diabetic control rats. No significant effect of resistant starch feeding on blood glucose and insulin was found. Even though the length of small intestines, and cecum, colon and rectum together with the tissue weight of cecum were not affected by feeding resistant starch, the intestinal transit time was markedly shortened by both types of resistant starch and resistant starch from corn had a more pronounced effect. The short chain fatty acids in the intestinal contents did not appear to be different among the groups. Nonetheless, both of resistant starch from corn and rice significantly lowered plasma total lipid and cholesterol concentrations compared to the diabetic control. The total liver cholesterol lowering effect was observed with resistant starch from rice. Neither immunoglobulin G nor C(3) were influenced by resistant starch.

Clonidine premedication prevents preoperative hypokalemia.

STUDY OBJECTIVE: To test the hypothesis that clonidine premedication could prevent an increase of plasma epinephrine occurring as a result of anxiety, and a decrease of the serum potassium (K+) levels before the induction of anesthesia. DESIGN: Randomized, double-blinded study. SETTING: University Hospital of Seoul. PATIENTS: 44 ASA physical status I and II patients, aged 20 to 50 years, scheduled for knee, ear, or nose surgery. INTERVENTION: 44 patients were randomly allocated into one of two groups: 22 patients (clonidine group) received clonidine 300 microg orally at 120 minutes before the induction of anesthesia. The other 22 patients (control group) received a placebo. MEASUREMENTS AND MAIN RESULTS: Anxiety level, serum K+, and plasma epinephrine were measured at an outpatient clinic, and immediately before the induction of anesthesia. There were no differences between groups in degree of anxiety experienced, serum K+, or plasma epinephrine levels as measured at the out-patient clinic. Immediately before the induction of anesthesia, the serum K+ levels of the clonidine group were higher than those of the control group (3.89 +/- 0.26 mEq/L vs. 3.50 +/- 0.36 mEq/L), and anxiety and plasma epinephrine levels of clonidine group were lower than those of the control group (p < 0.05). The frequency of hypokalemia (K+ < or = 3.5 mEq/L) of the clonidine group immediately before the induction of anesthesia was significantly lower than that of the control group (0% vs. 50%). CONCLUSIONS: Clonidine premedication was effective in preventing hypokalemic episodes occurring before the induction of anesthesia.