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Micro-arteriovenous fistula in patients with lower limb lymphedema

  • Kono, Hikaru;Sakuma, Hisashi;Watanabe, Shiho;Murayama, Takaya;Takemaru, Masashi
    • Archives of Plastic Surgery
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    • v.48 no.2
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    • pp.219-223
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    • 2021
  • Background A micro-arteriovenous fistula (AVF) is a minute, short shunt between an artery and a vein that does not pass through a capillary. We investigated the association between micro-AVFs and lymphedema using computed tomography angiography (CTA) and venous blood gas analysis. Methods In 95 patients with lower limb lymphedema, the presence or absence of early venous return (EVR) was compared between patients with primary and secondary lymphedema. Furthermore, we investigated the difference in the timing of edema onset in patients with secondary lymphedema with or without EVR using CTA. In 20 patients with lower limb lymphedema with confirmed early EVR in a unilateral lower limb, the partial pressure of oxygen (PO2) was compared between the lower limb with EVR and the contralateral lower limb. Results Secondary lymphedema with or without EVR occurred at an average of 36.0±59.3 months and 93.5±136.1 months, respectively; however, no significant difference was noted. PO2 was 57.6±11.7 mmHg and 44.1±16.4 mmHg in the EVR and non-EVR limbs, respectively, which was a significant difference (P=0.005). Conclusions EVR and venous blood gas analysis suggested the presence of micro-AVFs in patients with lower extremity edema. Further research is warranted to examine the cause of micro-AVFs, to advance technology to facilitate the confirmation of micro-AVFs by angiography, and to improve lymphedema by ligation of micro-AVFs.

Inhibition of Transient Receptor Potential Melastain 7 Enhances Apoptosis Induced by TRAIL in PC-3 cells

  • Lin, Chang-Ming;Ma, Ji-Min;Zhang, Li;Hao, Zong-Yao;Zhou, Jun;Zhou, Zhen-Yu;Shi, Hao-Qiang;Zhang, Yi-Fei;Shao, En-Ming;Liang, Chao-Zhao
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.10
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    • pp.4469-4475
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    • 2015
  • Transient receptor potential melastain 7 (TRPM7) is a bifunctional protein with dual structure of both ion channel and protein kinase, participating in a wide variety of diseases including cancer. Recent researches have reported the mechanism of TRPM7 in human cancers. However, the correlation between TRPM7 and prostate cancer (PCa) has not been well studied. The objective of this study was to investigate the potential the role of TRPM7 in the apoptosis of PC-3 cells, which is the key cell of advanced metastatic PCa. In this study, we demonstrated the influence and potential function of TRPM7 on the PC-3 cells apoptosis induced by TNF-related apoptosis inducing-ligand (TRAIL). The study also found a novel up-regulated expression of TRPM7 in PC-3 cells after treating with TRAIL. Suppression of TRPM7 by TRPM7 non-specific inhibitors ($Gd^{3+}$ or 2-aminoethoxy diphenylborate (2-APB) ) not only markedly eliminated TRPM7 expression level, but also increased the apoptosis of TRAIL-treated PC-3 cells, which may be regulated by the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway accompany with up-regulated expression of cleaved Caspase-3, (TRAIL-receptor 1, death receptors 4) DR4, and (TRAIL-receptor 2, death receptors 5) DR5. Taken together, our findings strongly suggested that TRPM7 was involved in the apoptosis of PC-3 cells induced by TRAIL, indicating that TRPM7 may be applied as a therapeutic target for PCa.

Difference in Right Ventricular Function between Post-tuberculosis Emphysema and Primary Emphysema (결핵후 폐기종과 원발성 폐기종에서 우심질 기능의 차이)

  • Kim, Myung-A;Kim, Sang-Hyun;Chung, Hee-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.2
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    • pp.97-107
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    • 2001
  • Background : Tuberculosis itself causes not only lung parenchymal destruction but also pulmonary vascular damage. Secondary emphysema also causes pulmonary vascular damage, which can develop as a late sequela of pulmonary tuberculosis. Therefore, pulmonary circulatory impairment tends to be more severe in post-tuberculosis emphysema than in primary emphysema. In post-tuberculosis emphysema, the right ventricular function may play an important role. However, little information regarding the right ventricular function is available. The purpose of this study was to evaluate and compare the right ventricular function between post-tuberculosis emphysema and primary emphysema. Method: Post-tuberculosis emphysema(PTE) or primary emphysema(PE) was diagnosed by history, HRCT finding and pulmonary function. Twenty patients with post-tuberculosis emphysema were matched with 20 patients with primary emphysema according to both $FEV-1$ and FVC. Arterial blood gas analysis and echocardiography were done at rest and immediately after symptom-limited exercise. The right ventricular function was evaluated with the right ventricular ejection fraction using a modification of Simpson's method. Results : There was no significant difference in the demographics and pulmonary function between the two groups. In post-tuberculosis emphysema, the $PaCO_2$ was higher ($42.9{\pm}4.7$ vs $38.8{\pm}3.1\;mmHg$ at rest; $47.9{\pm}7.0$ vs $41.1{\pm}5.9\;mmHg$ after exercise; p<0.01) and the right ventricular ejection fraction was lower ($57.6{\pm}6.5$ vs $61.4{\pm}4.7%$ at rest; $51.1{\pm}10.8$ vs $59.8{\pm}6.6%$ after exercise; p<0.01) both at rest and after exercise. The $PaCO_2$ after exercise was also lower ($65.7{\pm}12.6$ vs $80.2{\pm}14.4\;mmHg$, p<0.01), while the Pa02 at rest tended to be lower($82.9{\pm}12.0$ vs $87.8{\pm}7.5$, p>0.05). In both groups, right ventricular ejection fraction correlated with the $PaCO_2$ after exercise(PTE r=0.536, PE r=0.557), and the $PaCO_2$ at rest(PTE r=-0.576, PE r=-0.588) and after exercise(PTE r=-0.764, PE r=-0.619). Conclusion : Impairment of the right heart function and gas exchange were more serious in post-tuberculosis emphysema than in primary emphysema, and gas exchange may be influenced by the right ventricular function in post-tuberculosis emphysema.

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Characteristics of Lung Cancer in the Elderly (노령환자 폐암의 임상적 특징)

  • Jung, Kyung-Hae
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.5
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    • pp.660-668
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    • 1999
  • Background: Lung cancer continues to increase and one half of all cases of lung cancer occur in patients age 65 years and older. However, it seems that lung cancer is less treatable in elderly patients because of co-morbid illness or poor tolerance of surgery and chemotherapy. The intention of this study is to seek an adequate treatment approach for lung cancer in the elderly through an understanding of its characteristics. Method: The clinical data of 207 patients who were diagnosed with histologically proven lung cancer at the department of internal medicine in Seoul Municipal Boramae Hospital between September 1994 and August 1998 were retrospectively analyzed according to their age groups; group I$\geq$65 years(n=122) and group II<65 years(n=85). Results: The peak incidence of age was 7th decade(36.2%) and male age 65 years and older were 42% of all patients. Although dyspnea was more common in group I(26%) than in group II(11%)(p=.0l), there were no significant difference in other symptoms, stage, and histologic type between two groups. Group I significantly had more patients with poor performance(ECOG 3&4) than group II(35.2% vs.12.9%, p=.000). The percentage of patients with non-small cell carcinoma received supportive care only was significantly higher in group I than in group I(74% vs. 35%, p=.000). However, survival of patients who had curative intent treatment was similar between two groups(median survival 11.3 mos vs. 23 mos, p>.05). The histologic subtype, stage and performance status were significant prognostic factors affecting survival, but age itself was not. Conclusion : Lung cancer is prevalent in the elderly and aggressive diagnosis and treatment should be considered in elderly patients with good performance status.

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Finite Element Analysis for the Contact Stress of Ultra-high Molecular Weight Polyethylene in Total Knee Arthroplasty (전 슬관절 치환 성형술에 사용되는 초고분자량 폴리에틸렌 삽입물의 접촉응력에 관한 유한요소해석)

  • Jo, Cheol-Hyeong;Choe, Jae-Bong;Choe, Gwi-Won;Yun, Gang-Seop;Gang, Seung-Baek
    • Journal of Biomedical Engineering Research
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    • v.20 no.1
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    • pp.37-44
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    • 1999
  • Because of bone resorption, wear of ultra-high molecular weight polyethylene(UHMWPE) in total knee arthroplasty has been recognized as a major factor in long-term failure of knee implant. The surface damage and the following harmful wear debris of UHMWPE is largely related to contact stress. Most of the previous studies focused on the contact condition only at the articulating surface of UHMWPE. Recently, contact stress at the metal-backing interface has been implicated as one of major factors in UHMWPE wear. Therefore, the purpose of the is study is to investigate the effect of the contact stress for different thickness, conformity friction coefficient, and flexion degree of the UHMWPE component in total knee system, considering the contact conditions at both interfaces. In this study, a two-dimensional non-linear plane strain finite element model was developed. The results showed that the maximum value of von-Mises stress occurred below the articulating surface and the contact stress was lower for the more conforming models. All-polyethylene component showed lower stress distribution than the metal-backed component. With increased friction coefficient on the tibiofemoral contact surface, the maximum shear stress increased about twofold.

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A Study on Sociomedical Characteristics of Homeless People Reflected in Medical Records (의무기록에 반영된 부랑인 환자의 사회의료적 특성에 관한 고찰)

  • Park Hyo-Sook
    • Journal of Korean Public Health Nursing
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    • v.10 no.2
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    • pp.74-89
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    • 1996
  • It hasbeen individual and social problems that mattoids, alcohols and old people alienated from their families have wandered about the streets for rapid urbanzation, industrialization and nuclear families. In our country, measures for proper guidance for the tramps under the supports of government in 1982 have been carried out. But it has been difficult that we protected without Welfare Acts for them. According to those the study has aimed to provide for the fundamental data to advance public utilities as needs of an administrative organ with focus on contents of nursing records charts, furthermore general traits of subjects perceived details related to diseases. Medical record service has been a 'D' municipal hospital. All the subjects were a total of 4,855 persons, 2.436 in 1992, 2.419 in 1994. 1. Social Traits They mainly have attended a hospital, especially Thursday and Friday from a week and winter from the seasons. They equally have attended a hospital in the beginning, middle and end of the month. They equally have attended a hospital in the months. Government and public offices such as police stations and district offices have trusted them to a hospital. After they left a hospital. their residence has been their home confirmed in the ratio of $59.2\%$. 2. Controling Characteristics of a Medical Institution The proportion of males to females was 7 to 1. In the ages, the adults at the first of adulthood from 25 years to 44 years were $52.6\%$ mostly entered a hospital. In the observations the percentage of patients should be entered total was $8.8\%$. In general. the proportion of changes by fee was about $4\%$. Then the number of patients were on an average from 30. 76 to 32, 55 persons in 1992. It was from 25. 63 to 26. 87 in 1994. But the numbers were 5 to 6. It showed that the number was decreased. 3. Medical Traits The number of days by measured and the number of days which have been entered to a hospital have not made differences. The kinds of diseases were 1.11 in 1992. but were 1. 16 in 1994. In terms of 17 kinds of international diseases divided. the diseases recorded probably have been accidents. poisoning and violence( XVII). digestive trouble(IX). endoctrin disoders. metabolism and dystrophy(III) in orders, then they have been measured $51.0\%,\; 12.7\%,\; 6.8\%$. All patients who have been entered to a hospital severly have been drinking. As the seriousness of drinking and the kinds of diseases have indicated positively correlated. It have indicated that the more serious drinking have been. the more the number of diseases have been. As we have known according to abover results. the Acts for Homeless People related to special medical problems been have revised. furthemore they need to support the basic medical adds in order to maintaim their lives.

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Meta-analysis of Excision Repair Cross-complementation Group 1 (ERCC1) Association with Response to Platinum-based Chemotherapy in Ovarian Cancer

  • Li, Feng-Ying;Ren, Xiao-Bin;Xie, Xin-You;Zhang, Jun
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7203-7206
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    • 2013
  • Recent studies suggested that the ovarian cancers with negative excision repair cross-complementation group 1 enzyme (ERCC1) expression have a better response to platinum-based chemotherapy than those with positive ERCC1 expression. The objective of this study was to evaluate whether ERCC1 expression is associated with response to platinum-based chemotherapy in ovarian cancers. MEDLINE, PubMed, Web of Science and CNKI databases were used for searching studies relating to ERCC1 protein expression and response to platinum-based chemotherapy in ovarian cancers. Statistical analysis was based on the method for a fixed effects meta-analysis. Pooled odds ratios (ORs) with 95% confidence intervals for ERCC1 protein expression and response to platinum-based chemotherapy were generated. Publication bias was investigated with Begg's test. Five studies involving 306 patients with ovarian cancer were included. Compared to patients with positive ERCC1 expression, those with negative ERCC1 expression had a better response to platinum-based chemotherapy. The pooled OR was 5.264 (95% CI: 2.928-9.464, P < 0.001) and publication bias was not found (P = 0.904). The result was similar in both in Asians and Caucasians (P < 0.001 and P = 0.028, respectively). ERCC1 protein expression status is significantly associated with response to platinum-based chemotherapy in ovarian cancers.

The Comparison of Effects Mulligan's Technique Applied to Shortened Hamstring (단축된 슬괵근에 적용한 멀리건 기법의 효과 비교)

  • Choi, Yul-jung;Sim, Hyun-po;Lee, Jun-yong
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.24 no.1
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    • pp.7-14
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    • 2018
  • Background: The purpose of this study is to investigate the effects of Mulligan's bent leg raise (BLR), two leg rotation (TLR) and straight leg raise with traction (traction SLR) technique on the change of shortened hamstring length. Methods: Sixty subjects participated in this study. The subjects were randomly assigned to either the BLR group (n=20) or TLR group (n=20) or traction SLR group (n=20). 90-90 SLR test was performed for evaluation of hamstring shortening at initial time of study. After intervention, immediate effect(immediately after intervention) and effect of maintenance (after 60 minutes from intervention) were assessed. Results: All three groups showed significant differences in the immediate evaluation and the post evaluation after 60 minutes on the change of shortened hamstring length compared to the initial evaluation. When three groups were compared, in the immediate effect, BLR and traction SLR groups were higher than TLR group (p<.05). And the effect after 60 minutes, BLR group was higher than the other two groups (p<.05). Conclusion: In the results of this study, three groups showed immediately and lasting effectiveness in flexibility of shortened hamstring. In addition, BLR and traction SLR groups were more flexible than TLR group in the immediate evaluation and BLR group had better maintenance of flexibility than the other two groups in the post evaluation after 60 minutes.

Proximal ligation after the side-to-end anastomosis recovery technique for lymphaticovenous anastomosis

  • Suzuki, Yushi;Sakuma, Hisashi;Ihara, Jun;Shimizu, Yusuke
    • Archives of Plastic Surgery
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    • v.46 no.4
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    • pp.344-349
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    • 2019
  • Background Lymphaticovenous anastomosis is an important surgical treatment for lymphedema, with lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis being the most frequently performed procedures. However, LVSEA can cause lymphatic flow obstruction because of regurgitation and tension in the anastomosis. In this study, we introduce a novel and simple procedure to overcome this problem. Methods Thirty-five female patients with lower extremity lymphedema who underwent lymphaticovenous anastomosis at our hospital were included in this study. Eighty-five LVSEA procedures were performed, of which 12 resulted in insufficient venous blood flow. For these 12 anastomoses, the proximal lymphatic vessel underwent clipping after the anastomotic procedure and the venous inflow was monitored. Subsequently, the proximal ligation after side-to-end anastomosis recovery (PLASTER) technique, which involves ligating the proximal side of the lymphatic vessel, was applied. A postoperative evaluation was performed using indocyanine green 6 months after surgery. Results Despite the clipping procedure, three of the 12 anastomoses still showed poor venous inflow. Therefore, it was not possible to apply the PLASTER technique in those cases. Among the nine remaining anastomoses in which the PLASTER technique was applied, three (33%) were patent. Conclusions Our findings show that achieving patent anastomosis is challenging when postoperative venous inflow is poor. We achieved good results by performing proximal ligation after LVSEA. Thus, the PLASTER technique is a particularly useful recovery technique when LVSEA does not result in good run-off.

Does physiotherapy after rotator cuff repair require supervision by a physical therapist?: a meta-analysis

  • Masaki Karasuyama;Masafumi Gotoh;Takuya Oike;Kenichi Nishie;Manaka Shibuya;Hidehiro Nakamura;Hiroki Ohzono;Junichi Kawakami
    • Clinics in Shoulder and Elbow
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    • v.26 no.3
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    • pp.296-301
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    • 2023
  • Background: A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR. Methods: We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance. Results: The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, -8.51 points; 95% confidence interval [CI], -32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, -2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data. Conclusions: Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR. Level of evidence: I.