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1.  Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy 
Background. Laparoscopic lateral transperitoneal adrenalectomy (LTA) has been the standard method for resecting benign adrenal gland tumors. Recently, however, laparoscopic posterior retroperitoneal adrenalectomy (PRA) has been more popular as an alternative method. This systematic review evaluates current evidence on adrenalectomy techniques, comparing laparoscopic LTA with PRA and laparoscopic adrenalectomy with robotic adrenalectomy. Methods. PubMed, Embase, and ISI Web of Knowledge databases were searched systematically for studies comparing surgical outcomes of laparoscopic LTA versus PRA and laparoscopic versus robotic adrenalectomy. The studies were evaluated according to the PRISMA statement. Results. Eight studies comparing laparoscopic PRA and LTA showed that laparoscopic PRA was superior or at least comparable to laparoscopic LTA in operation time, blood loss, pain score, hospital stay, and return to normal activity. Conversion rates and complication rates were similar. Six studies comparing robotic and laparoscopic adrenalectomy found that outcomes and complications were similar. Conclusion. Laparoscopic PRA was more effective than LTA, especially in reducing operation time and hospital stay, but there was no evidence showing that robotic adrenalectomy was superior to laparoscopic adrenalectomy. Cost reductions and further technical advances are needed for wider application of robotic adrenalectomy.
doi:10.1155/2014/918346
PMCID: PMC4281398  PMID: 25587275
2.  Three-Tesla magnetic resonance elastography for hepatic fibrosis: Comparison with diffusion-weighted imaging and gadoxetic acid-enhanced magnetic resonance imaging 
World Journal of Gastroenterology : WJG  2014;20(46):17558-17567.
AIM: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imaging.
METHODS: Forty-two patients were included in the study. On MRE, mean stiffness values were measured on the elastograms in kilopascals. The apparent diffusion coefficient (ADC) of the liver was measured using DWI. On gadoxetic acid enhanced MR, the contrast enhancement index (CEI) was calculated as signal intensity (SI)post/SIpre, where SIpost is liver-to-muscle SI ratio on hepatobiliary phase images and SIpre is that on nonenhanced images. Correlation between aspartate aminotransferase to the platelet ratio index (APRI) and three MR parameters was assessed. Each MR parameter was compared between a hepatic fibrosis (HF) group and non-hepatic fibrosis (nHF) group.
RESULTS: Liver stiffness showed strong positive correlation with APRI [Spearman correlation coeffiecient (r) = 0.773, P < 0.0001], while ADC and CEI showed weak or prominent negative correlation (r = -0.28 and -0.321, respectively). In the HF group, only liver stiffness showed strong correlation with APRI (r = 0.731, P < 0.0001). Liver stiffness, ADC, and APRI were significantly different between the HF group and nHF group.
CONCLUSION: MRE at 3-Tesla could be a feasible method for the assessment of hepatic fibrosis.
doi:10.3748/wjg.v20.i46.17558
PMCID: PMC4265618  PMID: 25516671
Magnetic resonance elastography; Hepatic fibrosis; Diffusion weighted imaging; Gadoxetic acid enhanced magnetic resonance imaging; Serum markers
3.  Short-term interval combined chemoembolization and radiofrequency ablation for hepatocellular carcinoma 
World Journal of Gastroenterology : WJG  2014;20(35):12588-12594.
AIM: To investigate hepatic function after combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) with a short-term interval (0-2 d).
METHODS: A total of 115 patients with compensated liver cirrhosis underwent RFA combined with TACE at a time-interval of 0-2 d for the treatment of hepatocellular carcinoma (HCC) < 5.0 cm. There were 21 patients who received further hepatic directed treatment altering liver function within 12 mo after the combined therapy for HCC-recurrence, and were excluded. The remaining 94 patients who survived without HCC-recurrence were included in this retrospective study.
RESULTS: At 1 mo after treatment, Child-Pugh scores (CPs) remained unchanged in 89 of 94 patients (94.7%), and transiently increased by one-point in 5 patients (5.3%). However, the score returned to baseline score at 3 mo and was maintained until 6 mo in all patients. The baseline CPs of 8 or more was identified as a factor for transient rise of CPs after the treatment (CPs 8/9 vs 5/6/7; 21.4% vs 2.5%; P = 0.022). At 12 mo follow-up, CPs was unchanged in 90 patients (95.7%), and increased by one-point in 4 patients (4.3%). The rise of CPs at 12 mo was not statistically associated with the initial transient rise of CPs. There were procedure-related complications in 3 patients (3.2%), but the complications were resolved by medical and interventional treatments without hepatic functional sequelae.
CONCLUSION: The combined TACE and RFA with an interval of 0-2 d are safe for the management of HCC < 5 cm in cirrhotic patients.
doi:10.3748/wjg.v20.i35.12588
PMCID: PMC4168095  PMID: 25253962
Child-Pugh score; Liver cirrhosis; Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Radiofrequency ablation
4.  The influence of thread geometry on implant osseointegration under immediate loading: a literature review 
Implant success is achieved by the synergistic combination of numerous biomechanical factors. This report examines the mechanical aspect of implants. In particular, it is focused on macrodesign such as thread shape, pitch, width and depth, and crestal module of implants. This study reviews the literature regarding the effect of implant thread geometry on primary stability and osseointegration under immediate loading. The search strategy included both in vitro and in vivo studies published in the MEDLINE database from January 2000 to June 2014. Various geometrical parameters are analyzed to evaluate their significance for optimal stress distribution, implant surface area, and bone remodeling responses during the process of osseointegration.
doi:10.4047/jap.2014.6.6.547
PMCID: PMC4279055  PMID: 25551016
Dental implants; Implant macrodesign; Thread geometry; Primary stability; Immediate loading
5.  Bioelectric modulation of wound healing in a 3D in vitro model of tissue-engineered bone 
Biomaterials  2013;34(28):6695-6705.
Long-standing interest in bioelectric regulation of bone fracture healing has primarily focused on exogenous stimulation of bone using applied electromagnetic fields. Endogenous electric signals, such as spatial gradients of resting potential among non-excitable cells in vivo, have also been shown to be important in cell proliferation, differentiation, migration, and tissue regeneration, and may therefore have as-yet unexplored therapeutic potential for regulating wound healing in bone tissue. To study this form of bioelectric regulation, there is a need for three-dimensional (3D) in vitro wound tissue models that can overcome limitations of current in vivo models. We present a 3D wound healing model in engineered bone tissue that serves as a pre-clinical experimental platform for studying electrophysiological regulation of wound healing. Using this system, we identified two electrophysiology-modulating compounds, glibenclamide and monensin, that augmented osteoblast mineralization. Of particular interest, these compounds displayed differential effects in the wound area compared to the surrounding tissue. Several hypotheses are proposed to account for these observations, including the existence of heterogeneous subpopulations of osteoblasts that respond differently to bioelectric signals, or the capacity of the wound-specific biochemical and biomechanical environment to alter cell responses to electrophysiological treatments. These data indicate that a comprehensive characterization of the cellular, biochemical, biomechanical, and bioelectrical components of in vitro wound models is needed to develop bioelectric strategies to control cell functions for improved bone regeneration.
doi:10.1016/j.biomaterials.2013.05.040
PMCID: PMC3724996  PMID: 23764116
6.  Comparison of the serum fibrin-fibrinogen degradation products with cytokeratin 19 fragment as biomarkers in patients with lung cancer 
Biomedical Reports  2014;2(5):737-742.
Lung cancer is one of the main causes of cancer-related mortality. The identification of early diagnostic biomarkers improved outcomes for lung cancer patients. Serum fibrin-fibrinogen degradation products (FDP) levels are elevated in numerous malignancies due to hemostatic alterations. The serum FDP levels were compared to the levels of cytokeratin 19 fragment antigen (CYFRA 21-1), another well-established biomarker. The serum samples from 193 lung cancer patients, 84 healthy controls and 106 patients with benign respiratory diseases were obtained. The serum FDP level was measured using the DR-70 immunoassay and the CYFRA 21-1 level was measured by electrochemiluminescence using the Roche Analytics E170. Receiver operating characteristics curves were used to assess the predictive sensitivity and specificity. The mean serum FDP level in lung cancer patients (35.01±229.02 μg/ml) was significantly higher compared to the 190 non-cancerous subjects (0.60±0.75 μg/ml; P=0.039). The mean serum CYFRA 21-1 level in lung cancer patients (4.50±6.67 ng/ml) was also significantly higher compared to the non-cancerous subjects (1.40±0.83 ng/ml; P<0.05). FDP exhibited clinical sensitivity and specificity of 86 and 75%, respectively, at an optimal cut-off at 0.67 μg/ml. CYFRA 21-1 exhibited clinical sensitivity and specificity of 77 and 74%, respectively, at a cut-off of 1.65 ng/ml. The serum FDP area under the curve (0.87) was slightly higher compared to CYFRA 21-1 (0.83). Therefore, it is apparent that serum FDP is comparable to CYFRA 21-1 as a lung cancer biomarker and can be used for clinical practice.
doi:10.3892/br.2014.315
PMCID: PMC4106540  PMID: 25054020
lung cancer; fibrin-fibrinogen degradation products; DR-70 immunoassay; cytokeratin 19 fragment; biomarker
7.  Delayed hepatic rupture after radiofrequency ablation for colorectal hepatic metastasis: management with transcatheter arterial embolization 
Intraperitoneal bleeding after radiofrequency ablation (RFA) is the most common major vascular complication due to direct needle injury to a vessel or liver capsule. However, intraperitoneal bleeding as a result of a delayed hepatic rupture after RFA for liver tumors is an extremely rare complication. The present report describes a case of intraperitoneal hemorrhage caused by delayed hepatic rupture resulting from arterioportal fistula after RFA for hepatic metastasis from colorectal cancer and successful management using transcatheter embolization.
doi:10.4174/astr.2014.87.1.41
PMCID: PMC4091438  PMID: 25025026
Liver; Colorectal neoplasms; Pulsed radiofrequency treatment; Therapeutic embolization
8.  MicroRNAs in lung cancer 
World Journal of Methodology  2014;4(2):59-72.
MicroRNAs have become recognized as key players in the development of cancer. They are a family of small non-coding RNAs that can negatively regulate the expression of cancer-related genes by sequence-selective targeting of mRNAs, leading to either mRNA degradation or translational repression. Lung cancer is the leading cause of cancer-related death worldwide with a substantially low survival rate. MicroRNAs have been confirmed to play roles in lung cancer development, epithelial-mesenchymal transition and response to therapy. They are also being studied for their future use as diagnostic and prognostic biomarkers and as potential therapeutic targets. In this review we focus on the role of dysregulated microRNA expression in lung tumorigenesis. We also discuss the role of microRNAs in therapeutic resistance and as biomarkers. We further look into the progress made and challenges remaining in using microRNAs for therapy in lung cancer.
doi:10.5662/wjm.v4.i2.59
PMCID: PMC4202482  PMID: 25332906
Lung cancer; MicroRNA; MiRNA
9.  The Administrative Process for Recognition and Compensation for Occupational Diseases in Korea 
Journal of Korean Medical Science  2014;29(Suppl):S3-S11.
In the Workers' Compensation Insurance (WCI) system in Korea, occupational diseases (ODs) are approved through deliberation meetings of the Committee on Occupational Disease Judgment (CODJ) after disease investigations when workers or medical institutions requested the Korea Workers' Compensation and Welfare Service (COMWEL) for medical care benefits. Insufficient data presented by employers or workers or lack of objective evidence may increase the possibility of disapproval. The expertise of accident investigation staff members should be reinforced and employers' and related institutions' obligations to cooperate and submit data should be specified under the law. The deliberation meetings of the CODJ are held separately for musculoskeletal, cerebro-cardiovascular, and medical diseases, and the judgments of ODs are made by the chairperson of COMWEL and six committee members by majority vote by issue. To reinforce the expertise of the members of the CODJ, periodic education and a system to accredit the committee members after appropriate education should be introduced. To fairly and quickly compensate for diseases that occur in workers, the criteria for the recognition of occupational diseases should be continuously amended and the systems for disease investigations and judgments should be continuously improved.
Graphical Abstract
doi:10.3346/jkms.2014.29.S.S3
PMCID: PMC4085172  PMID: 25006321
Occupational Diseases; Workers' Compensation; Korea
10.  Long-term Results from Cyclocryotherapy Applied to the 3O'clock and 9O'clock Positions in Blind Refractory Glaucoma Patients 
Purpose
To report the long-term follow-up results after cyclocryotherapy, applied to the 3-o'clock and 9-o'clock positions in blind refractory glaucoma patients.
Methods
We retrospectively reviewed the charts of 19 blind patients, and a total of 20 eyes with refractory glaucoma who were treated with cyclocryotherapy. Cyclocryotherapy treatments were performed using a retinal cryoprobe. The temperature of each cyclocryotherapy spot was -80℃ and each spot was maintained in place for 60 seconds. Six cyclocryotherapy spots were placed in each quadrant, including the 3-o'clock and 9-o'clock positions.
Results
The mean baseline pretreatment intraocular pressure (IOP) in all eyes was 50.9 ± 12.5 mmHg, which significantly decreased to a mean IOP at last follow-up of 14.1 ± 7.1 mmHg (p < 0.001). The mean number of antiglaucoma medications that patients were still taking at last follow-up was 0.3 ± 0.6. Devastating post-procedure phthisis occurred in only one eye.
Conclusions
Cyclocryotherapy, performed at each quadrant and at the 3-o'clock and 9-o'clock position, is an effective way to lower IOP and, thus, is a reasonable treatment option for refractory glaucoma patients who experience with ocular pain and headaches.
doi:10.3341/kjo.2015.29.1.47
PMCID: PMC4309868  PMID: 25646060
Cryotherapy; Refractory glaucoma
11.  Erythrophagocytosis of Lead-Exposed Erythrocytes by Renal Tubular Cells: Possible Role in Lead-Induced Nephrotoxicity 
Environmental Health Perspectives  2014;123(2):120-127.
Background: Nephrotoxicity associated with lead poisoning has been frequently reported in epidemiological studies, but the underlying mechanisms have not been fully described.
Objectives: We examined the role of erythrocytes, one of the major lead reservoirs, in lead-associated nephrotoxicity.
Methods and results: Co-incubation of lead-exposed human erythrocytes with HK-2 human renal proximal tubular cells resulted in renal tubular cytotoxicity, suggesting a role of erythrocytes in lead-induced nephrotoxicity. Morphological and flow cytometric analyses revealed that HK-2 cells actively phagocytized lead-exposed erythrocytes, which was associated with phosphatidylserine (PS) externalization on the erythrocyte membrane and generation of PS-bearing microvesicles. Increased oxidative stress and up-regulation of nephrotoxic biomarkers, such as NGAL, were observed in HK-2 cells undergoing erythrophagocytosis. Moreover, TGF-β, a marker of fibrosis, was also significantly up-regulated. We examined the significance of erythrophagocytosis in lead-induced nephrotoxicity in rats exposed to lead via drinking water for 12 weeks. We observed iron deposition and generation of oxidative stress in renal tissues of lead-exposed rats, as well as the histopathological alterations such as tubulointerstitial lesions, fibrosis, and up-regulation of KIM-1, NGAL, and TGF-β.
Conclusions: Our data strongly suggest that erythrophagocytosis and subsequent iron deposition in renal tubular cells could significantly enhance nephrotoxicity following lead exposure, providing insight on lead-associated kidney damages.
Citation: Kwon SY, Bae ON, Noh JY, Kim K, Kang S, Shin YJ, Lim KM, Chung JH. 2015. Erythrophagocytosis of lead-exposed erythrocytes by renal tubular cells: possible role in lead-induced nephrotoxicity. Environ Health Perspect 123:120–127; http://dx.doi.org/10.1289/ehp.1408094
doi:10.1289/ehp.1408094
PMCID: PMC4314246  PMID: 25302504
12.  Cetaceans evolution: insights from the genome sequences of common minke whales 
BMC Genomics  2015;16(1):13.
Background
Whales have captivated the human imagination for millennia. These incredible cetaceans are the only mammals that have adapted to life in the open oceans and have been a source of human food, fuel and tools around the globe. The transition from land to water has led to various aquatic specializations related to hairless skin and ability to regulate their body temperature in cold water.
Results
We present four common minke whale (Balaenoptera acutorostrata) genomes with depth of ×13 ~ ×17 coverage and perform resequencing technology without a reference sequence. Our results indicated the time to the most recent common ancestors of common minke whales to be about 2.3574 (95% HPD, 1.1521 – 3.9212) million years ago. Further, we found that genes associated with epilation and tooth-development showed signatures of positive selection, supporting the morphological uniqueness of whales.
Conclusions
This whole-genome sequencing offers a chance to better understand the evolutionary journey of one of the largest mammals on earth.
Electronic supplementary material
The online version of this article (doi:10.1186/s12864-015-1213-1) contains supplementary material, which is available to authorized users.
doi:10.1186/s12864-015-1213-1
PMCID: PMC4311506  PMID: 25609461
Cetaceans; Common minke whale; Positive selection; Genome
13.  Test Execution Variation in Peritoneal Lavage Cytology Could Be Related to Poor Diagnostic Accuracy and Stage Migration in Patients with Gastric Cancer 
Journal of Gastric Cancer  2013;13(4):214-225.
Purpose
Peritoneal lavage cytology is part of the routine staging workup for patients with advanced gastric cancer. However, no quality assurance study has been conducted to show variations or biases in peritoneal lavage cytology results. The aim of this study was to demonstrate a test execution variation in peritoneal lavage cytology between investigating surgeons.
Materials and Methods
A prospective cohort study was designed for determination of the positive rate of peritoneal lavage cytology using a liquid-based preparation method in patients with potentially curable advanced gastric cancer (cT2~4/N0~2/M0). One hundred thirty patients were enrolled and underwent laparotomy, peritoneal lavage cytology, and standard gastrectomy, which were performed by 3 investigating surgeons. Data were analyzed using the chi-square test and a logistic regression model.
Results
The overall positive peritoneal cytology rate was 10.0%. Subgroup positive rates were 5.3% in pT1 cancer, 2.0% in pT2/3 cancer, 11.1% in pT4a cancer, and 71.4% in pT4b cancer. In univariate analysis, positive peritoneal cytology showed significant correlation with pT stage, lymphatic invasion, vascular invasion, ascites, and the investigating surgeon. We found the positive rate to be 2.1% for surgeon A, 10.2% for surgeon B, and 20.6% for surgeon C (P=0.024). Multivariate analysis identified pT stage, ascites, and the investigating surgeon to be significant risk factors for positive peritoneal cytology.
Conclusions
The peritoneal lavage cytology results were significantly affected by the investigating surgeon, providing strong evidence of test execution variation that could be related to poor diagnostic accuracy and stage migration in patients with advanced gastric cancer.
doi:10.5230/jgc.2013.13.4.214
PMCID: PMC3915183  PMID: 24511417
Cytology; Peritoneal lavage; Stomach neoplasms; Variation; Cytology
14.  Radionuclide Labeling and Evaluation of Candidate Radioligands for PET Imaging of Histone Deacetylase in the Brain 
Histone deacetylases (HDACs) regulate gene expression by inducing conformational changes in chromatin. Ever since the discovery of a naturally occurring HDAC inhibitor, trichostatin A (TSA) stimulated the recent development of suberoylanilide (SAHA, Zolinza®), HDAC has become an important molecular target for drug development. This has created the need to develop specific in vivo radioligands to study epigenetic regulation and HDAC engagement for drug development for diseases including cancer and psychiatric disorders. 6-([18F]Fluoroacetamido)-1-hexanoicanilide ([18F]FAHA) was recently developed as a HDAC substrate and shows moderate blood-brain barrier (BBB) permeability and specific signal (by metabolic trapping/or deacetylation) but rapid metabolism. Here, we report the radiosynthesis of two carbon-11 labeled candidate radiotracers (substrate- and inhibitor-based radioligand) for HDAC and their evaluation in non-human primate brain. PET studies showed very low brain uptake and rapid metabolism of both labeled compounds but revealed a surprising enhancement of brain penetration by F for H substitution when comparing one of these to [18F]FAHA. Further structural refinement is needed for the development of brain-penetrant, metabolically stable HDAC radiotracers and to understand the role of fluorine substitution on brain penetration.
doi:10.1016/j.bmcl.2013.10.038
PMCID: PMC4007514  PMID: 24210501
Carbon-11; Positron Emission Tomography; SAHA; Brain; Epigenetics; Brain permeability
15.  Synthesis of Ordered Mesoporous Phenanthrenequinone-Carbon via π-π Interaction-Dependent Vapor Pressure for Rechargeable Batteries 
Scientific Reports  2014;4:7404.
The π-π interaction-dependent vapour pressure of phenanthrenequinone can be used to synthesize a phenanthrenequinone-confined ordered mesoporous carbon. Intimate contact between the insulating phenanthrenequinone and the conductive carbon framework improves the electrical conductivity. This enables a more complete redox reaction take place. The confinement of the phenanthrenequinone in the mesoporous carbon mitigates the diffusion of the dissolved phenanthrenequinone out of the mesoporous carbon, and improves cycling performance.
doi:10.1038/srep07404
PMCID: PMC4261180  PMID: 25490893
16.  Crystallization and preliminary X-ray crystallographic analysis of the oxysterol-binding protein Osh3 from Saccharomyces cerevisiae  
The PH domain and ORD of the oxysterol-binding protein Osh3 from S. cerevisae were crystallized and X-ray diffraction data were collected.
Oxysterol-binding protein (OSBP) related proteins (ORPs) are conserved from yeast to humans and are implicated in regulation of sterol homeostasis and in signal transduction pathways. Osh3 of Saccharomyces cerevisiae is a pleckstrin-homology (PH) domain-containing ORP member that regulates phosphoinositide metabolism at endoplasmic reticulum–plasma membrane contact sites. The N-terminal PH domain of Osh3 was purified and crystallized as a lysozyme fusion and the resulting crystal diffracted to 2.3 Å resolution. The crystal belonged to the monoclinic space group C2, with unit-cell parameters a = 98.03, b = 91.31, c = 84.13 Å, β = 81.41°. With two molecules in the asymmetric unit, the Matthews coefficient was 3.13 Å3 Da−1. Initial attempts to solve the structure by molecular-replacement techniques using T4 lysozyme as a search model were successful. The C-terminal OSBP-related domain (OBD) of Osh3 was crystallized by the vapour-diffusion method and the resulting crystal diffracted to 1.5 Å resolution. The crystal was orthorhombic, belonging to space group P212121, with unit-cell parameters a = 41.57, b = 87.52, c = 100.58 Å. With one molecule in the asymmetric unit, the Matthews coefficient was 2.01 Å3 Da−1. Initial attempts to solve the structure by the single-wavelength anomalous dispersion technique using bromine were successful.
doi:10.1107/S1744309112042510
PMCID: PMC3509973  PMID: 23192032
oxysterol-binding protein; Osh3; Saccharomyces cerevisiae
17.  Correlation between micrometer-scale ripple alignment and atomic-scale crystallographic orientation of monolayer graphene 
Scientific Reports  2014;4:7263.
Deformation normal to the surface is intrinsic in two-dimensional materials due to phononic thermal fluctuations at finite temperatures. Graphene's negative thermal expansion coefficient is generally explained by such an intrinsic property. Recently, friction measurements on graphene exfoliated on a silicon oxide surface revealed an anomalous anisotropy whose origin was believed to be the formation of ripple domains. Here, we uncover the atomistic origin of the observed friction domains using a cantilever torsion microscopy in conjunction with angle-resolved photoemission spectroscopy. We experimentally demonstrate that ripples on graphene are formed along the zigzag direction of the hexagonal lattice. The formation of zigzag directional ripple is consistent with our theoretical model that takes account of the atomic-scale bending stiffness of carbon-carbon bonds and the interaction of graphene with the substrate. The correlation between micrometer-scale ripple alignment and atomic-scale arrangement of exfoliated monolayer graphene is first discovered and suggests a practical tool for measuring lattice orientation of graphene.
doi:10.1038/srep07263
PMCID: PMC4248276  PMID: 25434431
18.  Effects of Robot-assisted Gait Training Combined with Functional Electrical Stimulation on Recovery of Locomotor Mobility in Chronic Stroke Patients: A Randomized Controlled Trial 
Journal of Physical Therapy Science  2014;26(12):1949-1953.
[Purpose] The purpose of the present study was to investigate the effects of robot-assisted gait training combined with functional electrical stimulation on locomotor recovery in patients with chronic stroke. [Subjects] The 20 subjects were randomly assigned into either an experimental group (n = 10) that received a combination of robot-assisted gait training and functional electrical stimulation on the ankle dorsiflexor of the affected side or a control group (n = 10) that received robot-assisted gait training only. [Methods] Both groups received the respective therapies for 30 min/day, 3 days/week for 5 weeks. The outcome was measured using the Modified Motor Assessment Scale (MMAS), Timed Up-and-Go Test (TUG), Berg Balance Scale (BBS), and gait parameters through gait analysis (Vicon 370 motion analysis system, Oxford Metrics Ltd., Oxford, UK). All the variables were measured before and after training. [Results] Step length and maximal knee extension were significantly greater than those before training in the experimental group only. Maximal Knee flexion showed a significant difference between the experimental and control groups. The MMAS, BBS, and TUG scores improved significantly after training compared with before training in both groups. [Conclusion] We suggest that the combination of robot-assisted gait training and functional electrical stimulation encourages patients to actively participate in training because it facilitates locomotor recovery without the risk of adverse effects.
doi:10.1589/jpts.26.1949
PMCID: PMC4273065  PMID: 25540505
Robot-assisted gait training; Functional electrical stimulation; Chronic stroke
19.  Role of Peritoneal Lavage Cytology and Prediction of Prognosis and Peritoneal Recurrence After Curative Surgery for Colorectal Cancer 
Annals of Coloproctology  2014;30(6):266-273.
Purpose
In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection.
Methods
From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival.
Results
Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001).
Conclusion
Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.
doi:10.3393/ac.2014.30.6.266
PMCID: PMC4286773  PMID: 25580413
Peritoneal metastasis; Cytology; Colorectal neoplasms; Survival; Prognosis
20.  Psychological characteristics of Korean children and adolescents with type 1 diabetes mellitus 
Purpose
This study investigates the behavioral and emotional characteristics of Korean children and adolescents with type 1 diabetes mellitus (T1DM) as compared to healthy controls, and examines whether their psychological status is associated with glycemic control, insulin regimens, or disease duration.
Methods
A total of 37 Korean children and adolescents with T1DM, aged 6-17 years, and 38 sex- and age-matched healthy controls were included in this study. Psychological distress was assessed using the Korean child behavior checklist (K-CBCL) and children's depression inventory (CDI) after the subjects and their parents were interviewed.
Results
The CDI and K-CBCL scores were significantly higher in T1DM subjects compared to normal controls. The T1DM subjects with "poorly controlled" blood glucose (glycosylated hemoglobin ≥8%) and "old patients" (disease duration ≥1 year) had a tendency to show higher CDI and K-CBCL scores. There were no significant differences in CDI and K-CBCL scores between the intensive and conventional insulin therapy groups.
Conclusion
Children and adolescents with T1DM seem to have inferior psychological adjustment to their normal counterparts, which might be associated with glycemic control and disease duration. Psychological evaluation and intervention should be considered in the management of T1DM in children and adolescents.
doi:10.6065/apem.2013.18.3.122
PMCID: PMC4027070  PMID: 24904865
Type 1 diabetes mellitus; Diabetes; Psychosocial; K-CBCL; CDI
21.  A new strategy for integrating abundant oxygen functional groups into carbon felt electrode for vanadium redox flow batteries 
Scientific Reports  2014;4:6906.
The effects of surface treatment combining corona discharge and hydrogen peroxide (H2O2) on the electrochemical performance of carbon felt electrodes for vanadium redox flow batteries (VRFBs) have been thoroughly investigated. A high concentration of oxygen functional groups has been successfully introduced onto the surface of the carbon felt electrodes by a specially designed surface treatment, which is mainly responsible for improving the energy efficiency of VRFBs. In addition, the wettability of the carbon felt electrodes also can be significantly improved. The energy efficiency of the VRFB cell employing the surface modified carbon felt electrodes is improved by 7% at high current density (148 mA cm−2). Such improvement is attributed to the faster charge transfer and better wettability allowed by surface-active oxygen functional groups. Moreover, this method is much more competitive than other surface treatments in terms of processing time, production costs, and electrochemical performance.
doi:10.1038/srep06906
PMCID: PMC4219165  PMID: 25366060
22.  Delayed Cerebral Hyperperfusion Syndrome Three Weeks after Carotid Artery Stenting Presenting as Status Epilepticus 
Cerebral hyperperfusion syndrome (CHS) is increasingly recognized as an uncommon, but serious, complication subsequent to carotid artery stenting (CAS) and carotid endarterectomy (CEA). The onset of CHS generally occurs within two weeks of CEA and CAS, and a delay in the onset of CHS of over one week after CAS is quite rare. We describe a patient who developed CHS three weeks after CAS with status epilepticus.
doi:10.3340/jkns.2014.56.5.441
PMCID: PMC4273006  PMID: 25535525
Cerebral hyperperfusion syndrome; Carotid artery stenting; Carotid artery stenosis; Status epilepticus
23.  Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment 
Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P < 0.001). Changes of subjective symptom severity also showed significant improvement (P < 0.05). Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy.
doi:10.1155/2013/181769
PMCID: PMC3713604  PMID: 23935655
24.  Viability and Regeneration of Chondrocytes after Laser Cartilage Reshaping Using 1,460 nm Diode Laser 
Objectives
Cartilage reshaping by laser irradiation is used to correct septal and auricular cartilage deformities. Chondrocyte viability following laser irradiation and reshaping has been well established. However, the regeneration process of chondrocyte after laser irradiation has not been revealed yet. The aims of this study were to determine the mechanism of cartilaginous thermal injury and the regenerative process of damaged cartilage following laser irradiation.
Methods
Laser irradiation was performed on human septal cartilage and rabbit auricular cartilage using a 1,460-nm diode laser. We observed change in the shape of cartilage and evaluated the extent of cartilage injury using live/dead cell assay via confocal microscopy. Hoechst and propidium iodide (PI) staining was used to evaluate the mechanism of chondrocyte injury after laser irradiation. To evaluate the regeneration of cartilage, laser irradiated cartilages were reimplanted into a subperichondrial pocket and were harvested at 1, 2, and 4 weeks after reimplantation for viability assessment and histologic examination.
Results
Laser irradiation using a 1,460-nm diode laser produced a marked shape change in both human septal and rabbit auricular cartilages. Thermal damage on cartilage was correlated with the exposure time and the laser power. Hoechst and PI staining showed that chondrocyte death by laser irradiation was due to mainly necrosis, rather than apoptosis. In lower power treatment group (0.3 W and 0.5 W), all the chondrocytes regenerated within 4 weeks, however, in 1 W treatment group, chondrocytes could not regenerate until 4 weeks.
Conclusion
Reshaping of cartilage using 1,460 nm diode laser was attained concurrently with the thermal injury to the chondrocytes. The extent of thermal damage on chondrocytes was dependent on the exposure time and the laser power and the damaged chondrocytes irradiated with lower level of laser power could be regenerated after reimplantation into subperichondrial pocket.
doi:10.3342/ceo.2013.6.2.82
PMCID: PMC3687067  PMID: 23799165
Laser; Reshaping; Diode laser; Chondrocyte; Cartilage; Septoplasty
25.  Kisspeptin/G protein-coupled receptor-54 system as an essential gatekeeper of pubertal development 
Puberty is the end-point of a complex series of developmental events, defined by the dynamic interaction between genetic factors and environmental cues, ultimately leading to the attainment of reproductive capacity. Kisspeptins, products of the KISS1 gene, were originally identified as metastasis suppressor peptides with the ability to bind G protein-coupled receptors (GPR54). In 2003, loss-of-function mutations of the GPR54 gene were found in patients with hypogonadotropic hypogonadism. This finding triggered study of the role of the kisspeptin/GPR54 system as an essential gatekeeper of control of reproduction and pubertal development. Kisspeptins are very potent elicitors of gonadotropin secretion, primarily through stimulation of gonadotropin-releasing hormone release. KISS1 also functions as an essential integrator for peripheral inputs, including gonadal steroids and nutritional signals, and for controlling GnRH and gonadotropin secretion. Whether the kisspeptin/GPR54 system is the trigger for puberty onset and/or it operates as integrator and effector of up-stream regulatory factors warrants further investigation.
doi:10.6065/apem.2013.18.2.55
PMCID: PMC4027097  PMID: 24904852
Puberty; Gonadotropin-releasing hormone; Gonadotropins; Kisspeptin; G protein-coupled receptor-54; Leptin

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