Seong Taek Mun

Dietary carnosic acid suppresses hepatic steatosis formation via regulation of hepatic fatty acid metabolism in high-fat diet-fed mice

In this study, we examined the hepatic anti-steatosis activity of carnosic acid (CA), a phenolic compound of rosemary (Rosmarinus officinalis) leaves, as well as its possible mechanism of action, in a high-fat diet (HFD)-fed mice model. Mice were fed a HFD, or a HFD supplemented with 0.01% (w/w) CA or 0.02% (w/w) CA, for a period of 12 weeks, after which changes in body weight, blood lipid profiles, and fatty acid mechanism markers were evaluated. The 0.02% (w/w) CA diet resulted in a marked decline in steatosis grade, as well as in homeostasis model assessment of insulin resistance (HOMA-IR) index values, intraperitoneal glucose tolerance test (IGTT) results, body weight gain, liver weight, and blood lipid levels (P < 0.05). The expression level of hepatic lipogenic genes, such as sterol regulating element binding protein-1c (SREBP-1c), liver-fatty acid binding protein (L-FABP), stearoyl-CoA desaturase 1 (SCD1), and fatty acid synthase (FAS), was significantly lower in mice fed 0.01% (w/w) CA and 0.02% (w/w) CA diets than that in the HFD group; on the other hand, the expression level of β-oxidation-related genes, such as peroxisome proliferator-activated receptor α (PPAR-α), carnitine palmitoyltransferase 1 (CPT-1), and acyl-CoA oxidase (ACO), was higher in mice fed a 0.02% (w/w) CA diet, than that in the HFD group (P < 0.05). In addition, the hepatic content of palmitic acid (C16:0), palmitoleic acid (C16:1), and oleic acid (C18:1) was significantly lower in mice fed the 0.02% (w/w) CA diet than that in the HFD group (P < 0.05). These results suggest that orally administered CA suppressed HFD-induced hepatic steatosis and fatty liver-related metabolic disorders through decrease of de novo lipogenesis and fatty acid elongation and increase of fatty acid β-oxidation in mice.

Carnosic acid inhibits TLR4-MyD88 signaling pathway in LPS-stimulated 3T3-L1 adipocytes

BACKGROUND/OBJECTIVES Carnosic acid (CA), found in rosemary (Rosemarinus officinalis) leaves, is known to exhibit anti-obesity and anti-inflammatory activities. However, whether its anti-inflammatory potency can contribute to the amelioration of obesity has not been elucidated. The aim of the current study was to investigate the effect of CA on Toll-like receptor 4 (TLR4) pathways in the presence of lipopolysaccharide (LPS) in 3T3-L1 adipocytes. MATERIALS/METHODS 3T3-L1 adipocytes were treated with CA (0-20 µM) for 1 h, followed by treatment with LPS for 30 min; mRNA expression of adipokines and protein expression of TLR4-related molecules were then measured. RESULTS LPS-stimulated 3T3-L1 adipocytes showed elevated mRNA expression of tumor necrosis factor (TNF)-α, interleukin-6, and monocyte chemoattractant protein-1, and CA significantly inhibited the expression of these adipokine genes. LPS-induced up regulation of TLR4, myeloid differentiation factor 88, TNF receptor-associated factor 6, and nuclear factor-κB, as well as phosphorylated extracellular receptor-activated kinase were also suppressed by pre-treatment of 3T3-L1 adipocytes with CA. CONCLUSIONS Results of this study suggest that CA directly inhibits TLR4-MyD88-dependent signaling pathways and decreases the inflammatory response in adipocytes.

Primary malignant melanoma arising in a cystic teratoma

The malignant transformation of a cystic teratoma is a rare event, occurring in about 0.2% to 1.8%. Primary malignant melanoma arising from the ovary is extremely rare. A primary melanoma in an ovarian cystic teratoma originates most frequently at the dermoepidermal junction, similar to a cutaneous melanoma. Though there are no standard adjuvant regimens for the treatment of primary malignant melanoma of the ovary. We present another case report of malignant melanoma developing in cystic teratoma.

A comparison of oxycodone and fentanyl in intravenous patient-controlled analgesia after laparoscopic hysterectomy

Background We planned to compare the effect of intravenous oxycodone and fentanyl on post-operative pain after laparoscopic hysterectomy. Methods We examined 60 patients were randomized to postoperative pain treatment with either oxycodone (n = 30, Group O) or fentanyl (n = 30, Group F). The patients received 10 mg oxycodone/100 µg fentanyl with ketorolac 30 mg before the end of anesthesia and then continued with patient-controlled analgesia for 48 h postoperatively. Results The accumulated oxycodone consumption was less than fentanyl during 8, 24 and 48 h postoperatively. Numeric rating score of Group O showed significantly lower than that of Group F during 30 min, 2, 4, 8 and 24 h postoperatively. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea was higher in the Group O during the 24 and 48 h postoperative period. Conclusions Oxycodone IV-PCA was more advantageous than fentanyl IV-PCA for laparoscopic hysterectomy in view of accumulated oxycodone consumption, pain control and cost beneficial effect. However, patient satisfaction was not good in the group O compared to group F.

Oxycodone versus fentanyl for intravenous patient-controlled analgesia after laparoscopic supracervical hysterectomy: A prospective, randomized, double-blind study

Background: Oxycodone, a semisynthetic thebaine derivative opioid, is widely used for the relief of moderate to severe pain. The aim of this study was to compare the efficacy and side effects of oxycodone and fentanyl in the management of postoperative pain by intravenous patient-controlled analgesia (IV-PCA) in patients who underwent laparoscopic supracervical hysterectomy (LSH). Methods: The 127 patients were randomized to postoperative pain treatment with either oxycodone (n = 64, group O) or fentanyl group (n = 63, group F). Patients received 7.5 mg oxycodone or 100 &mgr;g fentanyl with 30-mg ketorolac at the end of anesthesia followed by IV-PCA (potency ratio 75:1) for 48 hours postoperatively. A blinded observer assessed postoperative pain based on the numerical rating scale (NRS), infused PCA dose, patient satisfaction, sedation level, and side effects. Results: Accumulated IV-PCA consumption in group O was less (63.5 ± 23.9 mL) than in group F (85.3 ± 2.41 mL) during the first 48 hours postoperatively (P = 0.012). The NRS score of group O was significantly lower than that of group F at 4 and 8 hours postoperatively (P < .001); however, the incidence of postoperative nausea and vomiting (PONV), dizziness, and drowsiness was significantly higher in group O than in group F. Patient satisfaction was lower in group O than in group F during the 48 hours after surgery (P < 0.001). Conclusions: Oxycodone IV-PCA (potency ratio 1:75) provided superior analgesia to fentanyl IV-PCA after LSH; however, the higher incidence of side effects, including PONV, dizziness, and drowsiness, suggests that the doses used in this study were not equipotent.

Prognostic Value of Fluorine-18 Fluorodeoxyglucose Uptake of Bone Marrow on Positron Emission Tomography/Computed Tomography for Prediction of Disease Progression in Cervical Cancer

Objective This study aimed to evaluate the prognostic value of fluorine-18 fluorodeoxyglucose (FDG) uptake of bone marrow (BM) on positron emission tomography (PET)/computed tomography in patients with uterine cervical cancer. Methods One hundred forty-five patients with cervical cancer who underwent staging FDG PET/computed tomography and subsequent surgical resection or chemoradiotherapy were retrospectively enrolled in the study. Mean BM FDG uptake (BM standardized uptake value [SUV]) and BM-to-liver uptake ratio of FDG uptake (BLR) were measured. Relationships of BM SUV and BLR with hematologic and inflammatory markers were evaluated. Prognostic values of PET parameters for predicting disease progression-free survival and distant recurrence-free survival (DRFS) were assessed with a Cox proportional hazards regression model. Results Bone marrow SUV and BLR were significantly correlated with white blood cell count and neutrophil-to-lymphocyte ratio. In the multivariate Cox regression analysis, International Federation of Gynecology and Obstetrics stage (P = 0.048), neutrophil-to-lymphocyte ratio (P = 0.028), platelet-to-lymphocyte ratio (PLR; P = 0.004), maximum SUV of cervical cancer (P = 0.030), and BLR (P = 0.031) were significantly associated with progression-free survival, whereas lymph node metastasis (P = 0.041), PLR (P = 0.002), and BLR (P = 0.025) were significantly associated with DRFS. In a patient subgroup with chemoradiotherapy, BLR (P = 0.044) was still an independent prognostic factor for predicting DRFS in multivariate analysis along with PLR (P = 0.004). Conclusions In patients with cervical cancer, BLR is associated with an increased risk of disease progression and distant recurrence.

Epigallocatechin gallate with photodynamic therapy enhances anti-tumor effects in vivo and in vitro

OBJECTIVES To evaluate anti-tumor effects of combined photodynamic therapy and epigallocatechin-3-gallate (EGCG). MATERIALS AND METHODS TC-1 cells were injected into C57BL/6 mice. Mice were grouped by 7 into 4 groups as PDT, EGCG, combined PDT with EGCG, and control group. The photosensitizer Radachlorin was used. The light source was a diode laser with 662 nm wavelength. In vitro TC-1 cells were treated with Radachlorin and irradiated. In vivo, when tumors were 8-10mm, Radachlorin was injected into mice and irradiated. For in vitro, different doses of EGCG were added to culture dishes. For combination, EGCG was added to the cells. 2.5 or 5 μg/ml of Radachlorin was added to the cells. Cells were incubated with EGCG and/or Radachlorin and laser irradiated. In vivo, EGCG were given for 20 days, alone or after PDT treatment. Cell growth inhibition was determined using MTT assay. Tumor growth inhibition assays were done in each group. Tumor growth was measured using caliper. Western blottings were performed with primary antibodies as COX-2, p21, p53, PARP, Bax, P-p38, VEGF, HIF-1α, MMP9 and actin. RESULTS The cell growth and the tumor volume in PDT combined with EGCG treatment group was significantly suppressed, compared with control and PDT or EGCG alone treated groups. We have shown that PDT combined with EGCG in vivo increase levels of both p21 and p53. Both Bax and activated PARP genes were significantly expressed. CONCLUSIONS It is suggested that high anti-cancer activity of combined photodynamic therapy with EGCG may be useful for effective cancer therapy.

Recurrent alveolar soft part sarcoma of the uterine cervix

We previously reported the case of a patient with primary alveolar soft part sarcoma (ASPS) of the uterine cervix. To summarise, a 17-year-old nulliparous woman presented to our hospital for evalua...

A case of twin reversed arterial perfusion (TRAP) sequence misdiagnosed as a chorioangioma

A 33-year-old gravida 1, para 0 woman was referred to our hospital at 16 weeks of gestation, a single viable foetus and a second foetus with an absent foetal heart were identified by ultrasonography. The ultrasound images showed a twin monochorionic diamniotic intrauterine pregnancy, in which one twin was viable and the other had died. Detailed examination revealed normal morphology and growth of the first twin consistent with a gestational age of 16 weeks. Foetal echocardiography revealed normal parameters without any signs of cardiac failure in the first twin. The second twin showed hydropic features and absence of cardiac activity. The acardiac foetus showed disrupted growth and distorted foetal structures that made it difficult to identify detailed anatomy, except for the trunk. The placenta was in a posterior location and contained a cystic mass measuring 58.3 48.8mm (Figure 1(A)). The woman was informed that the dead foetus would be reabsorbed without affecting the surviving twin. At 23 weeks, the viable twin appeared normal, but the second twin was invisible. However, the placental cystic mass had increased dramatically, measuring 140 96mm (Figure 1(B)). The provisional radiological diagnosis was chorioangioma of the placenta, containing an anechoic, rounded cystic mass. At 29 weeks, the patient underwent an emergency caesarean section for severe oligohydramnios of the viable foetus. The viable foetus was male, weighing 890 g, with a 1-minute Apgar score of 3 and a 5-minute score of 7. However, the large cystic mass that was thought to be a chorioangioma of the placenta was, in fact, the demised acardiac twin. The acardiac foetus was delivered only after decompression of the large cystic spaces. This twin was grossly distorted, with multiloculated, subcutaneous fluid containing cystic spaces, no developed head, a round trunk-like structure and a tuft of coarse hair (Figure 1(C)).

A case of Hirschsprung’s disease diagnosed during pregnancy

A 32-year-old woman, at 21 weeks’ gestation of her second pregnancy, was admitted to our emergency department with nausea, vomiting, lower abdominal pain and difficulty of defecation. She had undergone appendectomy and a caesarean section delivery of a full-term healthy baby in her first pregnancy; and did not report previous medical disease. Her pregnancy had been uncomplicated thus far. Upon physical examination, she had normal vital signs. However, her abdomen was severely distended with epigastric tenderness. Digital rectal examination revealed a large amount of impacted stools. A trans-abdominal ultrasound examination revealed a singleton pregnancy inside the uterus and a hypoechoic solid mass over the pregnant uterus. Foetal biometry was equivalent to 21 weeks by ultrasound exam. Cardiotocography did not show signs of foetal distress, and gynaecological examination was not suggestive of preterm labour. During pregnancy, the patient was referred to magnetic resonance imaging (MRI), to better investigate the solid abdominal mass. MRI images showed marked distension of small and large bowel loop (Figure 1A and 1B), with faecal impaction, which had a mass effect over her uterus. We decided to hospitalise for observation and manage her distended bowel during pregnancy with only medical treatment including total parenteral nutrition. Despite the treatment, distension and abdominal pain worsened. At 32 weeks of gestation, our patient complained of colicky abdominal pain suggestive of a bowel obstruction. A non-stress test revealed foetal bradycardia. The patient underwent emergency caesarean section and subsequent laparotomy. A female neonate weighting 1970 g was delivered, with a 1minute Apgar score of 7and a 5-minute score of 10. The bowel was distended with faecal material retention. Our patient had ileostomy initially in order to decompress the distended bowel. The preterm infant survived with no complications. Four months later, the patient underwent total colectomy with ileorectal anastomosis in the Department of Surgery. Grossly, total colectomy specimen (length: 140.0 cm, the largest diameter: 11.5 cm, the smallest diameter: 5.3 cm) have approximately three segments – dilatation of normal bowel segment (length: 89.0 cm), contracted diseased segment (length: 6.3 cm) and transitional zone (Figure 1C and 1D). Microscopically, aganglionosis was found in the distal segment (5.3 cm). Only thick nerve fibre was demonstrated without ganglion cell in submucosal (Meissner’s) and myenteric (Auerbach’s) plexus (Figure 1E and 1F).