Han Sung Choi

Therapeutic Effect of Korean Red Ginseng on Inflammatory Cytokines in Rats with Focal Cerebral Ischemia/Reperfusion Injury

This study aims to identify the therapeutic effect of Korean red ginseng (KRG) on the expression of inflammatory cytokines in rats with focal cerebral ischemia/reperfusion injury. Adult male Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion (tMCAO) for two hours. They were fed KRG extract (100 mg/kg/day per orally) or saline after reperfusion. Tests for neurological deficits, using the modified neurologic severity score and the corner turn test, were performed before the ischemic event, and one, three, and seven days after tMCAO. Serum levels of cytokines were measured three and seven days after the operation, using enzyme-linked immunosorbent assays. The infarct volume was assessed after seven days by staining brain tissue with 2% 2, 3, 5-triphenyltetrazolium chloride. Oral administration of KRG significantly reduced the infarct volumes and rapidly improved neurological deficits. Serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and IL-6 were higher in tMCAO-operated rats than in the sham-operated rats. These changes were attenuated by daily KRG intake for seven days. Serum IL-10 levels were significantly increased in KRG-fed rats, as compared to sham-operated and saline-fed rats. Our results suggested that KRG provides neuroprotection for rats with focal cerebral ischemia/reperfusion injury. This neuroprotection may be due to raised IL-10 expression and a reduction in the serum levels of TNF-α, IL-1β, and IL-6.

Epigallocatechin Gallate Stimulates Glucose Uptake Through the Phosphatidylinositol 3-Kinase-Mediated Pathway in L6 Rat Skeletal Muscle Cells

The effect of epigallocatechin gallate (EGCG) on glucose uptake was studied in L6 rat skeletal muscle cells. Glucose uptake assay revealed that EGCG increased glucose uptake >70% compared to control. EGCG-stimulated glucose uptake was blocked by LY294002, an inhibitor of phosphatidylinositol (PI) 3-kinase, which is a major regulatory molecule in glucose uptake pathways. However, AMP-activated protein kinase (AMPK), which is another crucial mediator in independent glucose uptake pathways, did not inhibit EGCG-stimulated glucose uptake by SB203585, a specific inhibitor of the AMPK downstream mediator, p38 mitogen-activated protein kinase (MAPK). We also found that EGCG increased the phosphorylation level of protein kinase B and PI 3-kinase activity, when assessed by PI 3-kinase assay, whereas no increase in the phosphorylation level of AMPK and p38 MAPK was observed. Taken together, these results suggest that EGCG might stimulate glucose uptake, not AMPK-mediated but PI 3-kinase-mediated, in skeletal muscle cells, thereby contributing to glucose homeostasis.

Performance of the Geriatric Nutritional Risk Index in predicting 28-day hospital mortality in older adult patients with sepsis

BACKGROUND & AIMS The Geriatric Nutritional Risk Index (GNRI) is a screening tool for nutrition-related risk that correlates with mortality rate in hospitalized older patients and is simple, objective, and readily available to clinicians. In this study, we aimed to validate the performance of the GNRI in predicting short-term hospital mortality in older patients with sepsis. METHODS This observational study enrolled 401 older patients presenting with infection and systemic inflammatory response syndrome in an emergency department. Demographic, physiological, and laboratory data were collected. The GNRI score was categorized into five classes. The primary outcome was 28-day hospital mortality. Univariate and multivariate analyses were performed to identify clinical predictors of outcome. A logistic regression model was used. RESULTS 51 patients (12.7%) died in the hospital within 28 days. Co-morbid metastatic cancer, heart rate, respiratory rate, temperature, serum creatinine, total lymphocyte count, and GNRI (<87) were independently related to the outcome in the multivariable logistic regression analysis. CONCLUSIONS The GNRI is a prognostic factor for short-term hospital mortality in older patients with sepsis. A GNRI below 87 can be suggested as an indicator of nutritional support need in an acute-care setting.

Neuroprotective effects of consuming bovine colostrum after focal brain ischemia/reperfusion injury in rat model

To investigate the neuroprotective effects of bovine colostrums (BC), we evaluate the ability of consuming BC after focal brain ischemia/reperfusion injury rat model to reduce serum cytokine levels and infarct volume, and improve neurological outcome. Sprague-Dawley rats were randomly divided into 4 groups; one sham operation and three experimental groups. In the experimental groups, MCA occlusion (2 h) and subsequent reperfusion (O/R) were induced with regional cerebral blood flow monitoring. One hour after MCAO/R and once daily during the experiment, the experimental group received BC while the other groups received 0.9% saline or low fat milk (LFM) orally. Seven days later, serum pro-inflammatory cytokine (IL-1β, IL-6, and TNF-α) and anti-inflammatory cytokine (IL-10) levels were assessed. Also, the infarct volume was assessed by using a computerized image analysis system. Behavioral function was also assessed using a modified neurologic severity score and corner turn test during the experiment. Rats receiving BC after focal brain I/R showed a significant reduction (-26%/-22%) in infarct volume compared to LFM/saline rats, respectively (P < 0.05). Serum IL-1β, IL-6, and TNF-α levels were decreased significantly in rats receiving BC compared to LFM/saline rats (P < 0.05). In behavioral tests, daily BC intake showed consistent and significant improvement of neurological deficits for 7 days after MCAO/R. BC ingestion after focal brain ischemia/reperfusion injury may prevent brain injury by reducing serum pro-inflammatory cytokine levels and brain infarct volume in a rat model.

Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

Application of the Sequential Organ Failure Assessment (SOFA) score in patients with advanced cancer who present to the ED.

BACKGROUND There is limited literature describing clinical predictors for critically ill patients with cancer who present to the emergency department (ED). PURPOSE The aim of this study was to investigate the usefulness of the Sequential Organ Failure Assessment (SOFA) score at the time of ED presentation for predicting short-term mortality in patients with advanced cancer. METHODS This was a prospective observational study of 108 consecutive patients with advanced cancer who presented to the ED. The outcome was defined as death within 14 days after admission. RESULTS The median survival time of the study subjects was 26.5 days (interquartile range, 9.0-78.0 days), and 31 patients (28.7%) died within 14 days after admission. In univariate analysis, SOFA score (≥4), previous chemotherapy, and altered mental status were predictive of 14-day mortality. Of those variables, only SOFA score was an independent predictor in multivariate analysis. CONCLUSIONS The use of the SOFA score is an acceptable method for risk stratification and prognosis of patients with advanced cancer in the ED. This score can help clinicians to predict 14-day mortality and plan appropriate treatment for critically ill patients with cancer who present to the ED.

Association Study of Polymorphisms of Epidermal Growth Factor and Epidermal Growth Factor Receptor With Benign Prostatic Hyperplasia in a Korean Population

Purpose Recent studies have suggested that specific single-nucleotide polymorphisms (SNPs) contribute to the clinical features of benign prostatic hyperplasia (BPH). In this study, we investigated the relationships of genetic polymorphisms of the epidermal growth factor (EGF) gene and the epidermal growth factor receptor (EGFR) gene with BPH. Methods A total of 218 patients with BPH were enrolled in this study. We evaluated the relationship between eight SNPs in the EGF and EGFR genes and prostate volume, prostate-specific antigen (PSA), and International Prostate Symptom Score of BPH patients. Each SNP was genotyped by direct sequencing. Statistical analysis applying codominant, dominant, recessive, and log-additive models was performed via logistic regression. Results The rs11568943 and rs11569017 SNPs in the EGF gene showed significant associations with prostate volume (rs11568943: P=0.038 in the log-additive model, P=0.024 in the allele distribution; rs11569017, P=0.031 in the dominant model, P=0.028 in the log-additive model, P=0.020 in the allele distribution). Additionally, the rs3756261, rs11568943, and rs11569017 SNPs of the EGF gene and the rs2293347 SNP of the EGFR gene were associated with PSA levels (P<0.05 in each model, respectively). Conclusions These results suggest that the EGF gene may affect prostate volume. In addition, the EGF and EGFR genes may be associated with PSA levels in patients with BPH.

Near-complete optic nerve transection by high-pressure air

The use of high-pressure air instruments has become more common. Consequently, there have been a number of cases of orbital emphysema caused by contact with high-pressure air. In this case, a 62-year-old male patient visited an emergency medical center after his left eye was shot by an air compressor gun that was used to wash cars. Lacerations were observed in the upper and lower eyelids of his left eye. Radiological examinations revealed orbital emphysema, optic nerve transection, pneumocephalus, and subcutaneous emphysema in the face, neck, shoulder, and mediastinum. Canalicular injury repair was performed, and the emphysema resolved. However, there was near-complete vision loss in the patient’s left eye. Because most optic nerve transections occur after a severe disruption in bone structure, pure optic nerve transections without any injury of the bone structure, as in the present case, is extremely rare.

Traumatic Hemobilia Without Liver Parenchymal Injury Due to Blunt Trauma

A 47-year-old previously healthy man presented to the Emergency Department (ED) with epigastric pain. The patient had been kicked several times in his abdomen approximately 20 h before presenting to the ED. His vital signs included a temperature of 36.2°C, respiratory rate of 20 breaths/min, pulse rate of 76 beats/min, and a blood pressure of 160/90 mm Hg. The physical examination found diffuse tenderness over the epigastric and right upper quadrant of the abdomen, but no rebound tenderness or external wounds were observed. Laboratory studies revealed a hemoglobin level of 13.0 g/dL, hematocrit 36.4%, total bilirubin 2.9 mg/dL, aspartate aminotransferase 1049 units/L, and alanine aminotransferase 516 units/L. Urinalysis revealed more than 30 red blood cells per high power field. Bedside ultrasonography and standard radiographs were performed, but no abnormal findings were reported. An abdominal computed tomography (CT) scan was requested to investigate the possibility of liver or kidney injury and demonstrated high-attenuation lesions (40–50 Hounsfield units [HU]) in the gallbladder and common bile duct (CBD), and mild dilatation in the distal CBD (Figure 1). The patient had no hemoperitoneum or internal organ injury. He was diagnosed primarily as having an incidental distal CBD stone because the high-attenuation material may have been inspissated bile due to an impacted radiolucent stone in the CBD. Three