Hoon Pyo Hong

Treadmill exercise ameliorates dopaminergic neuronal loss through suppressing microglial activation in Parkinson's disease mice.

AIMS Parkinsons disease is a debilitating neurodegenerative disorder characterized by the gradual loss of dopaminergic neurons. We investigated the effects of treadmill exercise on dopaminergic neuronal loss and microglial activation using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/probenecid (MPTP/P)-induced Parkinsons disease mice. MAIN METHODS Parkinsons disease was induced in mice by injection of MPTP/P. The mice in the exercise groups were put on a treadmill to run for 30min/day, five times per week for four weeks. Motor balance and coordination was measured using rota-rod test. Expressions of inducible nitric oxide synthase (iNOS) and phosphorylated extracellular signal-regulated kinase (p-ERK), phosphorylated NH(2)-terminal kinase (p-JNK), phosphorylated p-38 (p-p38), CD200, and CD200 receptor were determined by western blotting. Expressions of tyrosine hydroxylase (TH) and CD11b were evaluated by immunohistochemistry. KEY FINDINGS Parkinsons disease mice displayed poor motor balance and coordination with loss of nigrostriatal dopaminergic neurons. iNOS expression was enhanced via up-regulation of phosphorylated mitogen-activated protein kinases (p-MAPKs) signaling, such as p-ERK, p-JNK, and p-p-38 in the Parkinsons disease mice. Microglial activation was also observed in the Parkinsons disease mice, showing increased CD11b expression with suppressed CD200 and CD200 receptor expressions. Treadmill exercise prevented the loss of nigrostriatal dopaminergic neurons, and ameliorated the motor balance and coordination dysfunction in the Parkinsons disease mice. Treadmill exercise suppressed iNOS expression via down-regulation of MAPKs and also inhibited microglial activation in the Parkinsons disease mice. SIGNIFICANCE Treadmill exercise prevented dopaminergic neuronal loss by inhibiting brain inflammation through suppression of microglial activation in the Parkinsons disease mice.

Focal osteolysis in total hip replacement: CT findings

ObjectiveTo describe the CT findings of focal osteolysis following total hip replacement (THR).Design and patientsCT imaging features of 30 THRs with focal osteolysis visualized on follow-up radiographs and undertaken revision surgery were reviewed. On CT scans, the shape and anatomic location of osteolytic lesions was recorded, as well as their size and number. The presence of cortical disruption or expansion, liner wear, metallosis, and heterotopic ossification was also noted. In each case, surgical and histologic findings were correlated with imaging features.ResultsFocal osteolysis was common in the superior part of acetabular and femoral components. CT features of focal osteolysis were multiple, expansile, oval, or round radiolucencies, which were conglomerated into multilobular shape. The cortex adjacent to the osteolytic lesions revealed irregular thinning and discontinuity (29/30, 97%) accompanied by a few tiny fragments. Liner wear was common (27/30, 90%), and metallosis was frequent (8/30, 26.7%). Pathologic results were foreign body reaction in 20 patients, chronic inflammation in eight, and fibrosis in two.ConclusionCT appearances of focal osteolysis following THR are multilobulated lucent areas with expansile periosteal reaction and cortical abnormalities, mimicking infection or tumor. We consider that CT is useful for the prediction and assessment of the nature and extent of focal osteolysis.

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.

Bulbous urethra involved in perineal extraskeletal myxoid chondrosarcoma in a child

Extraskeletal myxoid chondrosarcoma is a rare soft‐tissue sarcoma that usually occurs in deep soft tissues, especially those of the proximal extremities and limb girdles, but is rare in children. We present an unusual case of a tumor arising in the perineum and involving the bulbous urethra in a 21‐month‐old boy. The patient was treated with surgical excision and urethroplasty followed by combination chemotherapy.

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.

Serum C-reactive protein level is a predictive factor for 14-day mortality of patients with advanced cancer who present to the emergency department with acute symptoms.

OBJECTIVES This study aimed to investigate the potential of C-reactive protein (CRP) as a predictor of death within 14 days in acutely symptomatic patients with advanced cancer admitted to the emergency department (ED). METHODS A prospective observational study was conducted of 126 consecutive patients with advanced cancer who were admitted to the ED because of acute symptoms. The patients were categorized into two groups according to serum CRP levels (cutoff 9.2 mg/dL). Demographic characteristics, disease-related factors, clinical symptoms and signs, and laboratory data were collected. Univariate and multivariate analyses were performed to evaluate the relationship between clinical findings and 14-day mortality. RESULTS Median survival was 26.5 days (interquartile range = 8.0-79.5 days). In univariate analysis, serum CRP level (≥9.2 mg/dL), chemotherapy, age (≥65 years), altered mental status, hypotension, and leukocytosis were significant. Multivariate regression analysis revealed that among these variables, serum CRP level (hazard ratio [HR] = 2.444, 95% confidence interval [CI] = 1.298 to 4.603, p = 0.006) and chemotherapy (HR = 0.452, 95% CI = 0.236 to 0.863, p = 0.016) were independent prognostic factors for 14-day mortality. CONCLUSIONS Serum CRP levels may provide information on death within 14 days after the ED visit in patients with advanced cancer.

The possibility of application of spiral brain computed tomography to traumatic brain injury

OBJECTIVES The spiral computed tomography (CT) with the advantage of low radiation dose, shorter test time required, and its multidimensional reconstruction is accepted as an essential diagnostic method for evaluating the degree of injury in severe trauma patients and establishment of therapeutic plans. However, conventional sequential CT is preferred for the evaluation of traumatic brain injury (TBI) over spiral CT due to image noise and artifact. We aimed to compare the diagnostic power of spiral facial CT for TBI to that of conventional sequential brain CT. METHODS We evaluated retrospectively the images of 315 traumatized patients who underwent both brain CT and facial CT simultaneously. The hemorrhagic traumatic brain injuries such as epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and contusional hemorrhage were evaluated in both images. Statistics were performed using Cohens κ to compare the agreement between 2 imaging modalities and sensitivity, specificity, positive predictive value, and negative predictive value of spiral facial CT to conventional sequential brain CT. RESULTS Almost perfect agreement was noted regarding hemorrhagic traumatic brain injuries between spiral facial CT and conventional sequential brain CT (Cohens κ coefficient, 0.912). To conventional sequential brain CT, sensitivity, specificity, positive predictive value, and negative predictive value of spiral facial CT were 92.2%, 98.1%, 95.9%, and 96.3%, respectively. CONCLUSION In TBI, the diagnostic power of spiral facial CT was equal to that of conventional sequential brain CT. Therefore, expanded spiral facial CT covering whole frontal lobe can be applied to evaluate TBI in the future.

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.

P-177: The Sequential Organ Failure Assessment (SOFA) score is a predictive factor for 14-day mortality of elderly patients with advanced cancer who present to the ED

length of hospital stay after univariate analysis. Comparing with patients without anemia and BT as a reference, only patients who received BT had higher risk to have POD (anemia with BT: OR: 4.364, 95%CI: 1.580–12.053; without anemia but receiving BT: OR: 5.139, 95%CI: 1.848–14.294) after controlling confounders. Moreover, anemia is also not risk factor in both gender, and only men receiving BT had a significant risk for POD (OR 4.483; 95%CI: 1.266–15.869). Conclusions: Among older patients undergoing elective orthopedic surgery, receiving blood transfusion in operation is a significantly risk factor for postoperative delirium, not anemia at admission, and the risk was only found in men, not women.