Long-term fecal diverting device for the prevention of sepsis in case of colorectal anastomotic leakage: an animal experiment

BACKGROUND: A new fecal diverting device (FDD) was fabricated for fecal diversion from the proximal colon above the anastomosis to outside the anus for protecting the rectal anastomosis. The aim of the study is to evaluate the safety and effectiveness of the FDD. METHODS: After a pilot study, a prospective observational trial was performed in 34 mongrel dogs. The experiment comprised of segmental resection and anastomosis of the colon, fixation of the FDD, and observation for 3 weeks (n = 15) and more than 3 weeks (n = 19) without initiation of parenteral nutrition. RESULTS: Four cases of perioperative death unrelated to the FDD were excluded. Twenty-six (87 %) of the 30 dogs survived. Sixteen (53 %) dogs were able to retain the FDD for more than 3 weeks until 82 days. The autopsy findings revealed that four (15 %) dogs showed colonic wall erosions and mucosal scarring respectively at the band fixation area without evidence of serious septic complications. The surviving dogs retained the FDD for more than 6 days. Mortality occurred in four of the five dogs that expelled the FDD within three postoperative days. A closed abscess cavity as the evidence of anastomotic leakage was noted in seven (23 %) of the surviving dogs. CONCLUSIONS: The newly designed fecal diverting device can be retained for more than 3 weeks until 82 days without any serious complications. The FDD may prevent sepsis in case of anastomotic leakage if it is retained for more than 6 days.ope

Long-term treatment of allogeneic adipose-derived stem cells in a dog with rheumatoid arthritis

Background: Although there are growing demands for stem cell-based therapy for companion animals in various diseases, a few clinical trials have been reported. Moreover, most of them are the results from only one or a few times of stem cell injection. Objectives: The aim of this study is to describe a long-term treatment with allogeneic adipose-derived stem cells (ASCs) in a dog with rheumatoid arthritis (RA), which is a rare canine disease. Methods: The dog with RA received intravascular injection of allogeneic ASCs derived from two healthy donors once a month for 11 months. To assess therapeutic effects of ASCs, orthopedic examination and clinical evaluation was performed. Cytokines of tumor necrosis factor-α and interleukin-6 in the plasma were measured using ELISA analysis. Results: Despite this repeated and long-term administration of allogeneic ASCs, there were no side effects such as immunorejection responses or cell toxicity. The orthopedic examination score for the dog decreased after ASCs treatment, and the clinical condition of the dog and owner's satisfaction were very good. Conclusions: Although ASCs has been suggested as one of the options for RA treatment because of its anti-inflammatory and immunosuppressive functions, it has never been used to treat RA in dogs. The present report describes a case of canine RA treated with allogeneic ASCs for long-term in which the dog showed clinical improvement without adverse effects.ope

Viability assessment after conventional coronary angiography using a novel cardiovascular interventional therapeutic CT system: Comparison with gross morphology in a subacute infarct swine model

BACKGROUND: Given the lack of promptness and inevitable use of additional contrast agents, the myocardial viability imaging procedures have not been used widely for determining the need to performing revascularization. OBJECTIVE: This study is aimed to evaluate the feasibility of myocardial viability assessment, consecutively with diagnostic invasive coronary angiography (ICA) without use of additional contrast agent, using a novel hybrid system comprising ICA and multislice CT (MSCT). METHODS: In all, 14 Yucatan miniature swine models (female; age, 3 months; weight, 28-30 kg) were subjected to ICA followed by balloon occlusion (90 minutes) and reperfusion of the left anterior descending coronary artery. Two weeks after induction of myocardial infarction, delayed hyperenhancement (DHE) images were obtained, using a novel combined machine comprising ICA and 320-channel MSCT scanner (Aquilion ONE, Toshiba), after 2, 5, 7, 10, 15, and 20 minutes after conventional ICA. The heart was sliced in 10-mm consecutive sections in the short-axis plane and was embedded in a solution of 1% triphenyltetrazolium chloride (TTC). Infarct size was determined as TTC-negative areas as a percentage of total left ventricular area. On MSCT images, infarct size per slice was calculated by dividing the DHE area by the total slice area (%) and compared with histochemical analyses. RESULTS: Serial MSCT scans revealed a peak CT attenuation of the infarct area (222.5 ± 36.5 Hounsfield units) with a maximum mean difference in CT attenuation between the infarct areas and normal myocardium of at 2 minutes after contrast injection (106.4; P for difference = 0.002). Furthermore, the percentage difference of infarct size by MSCT vs histopathologic specimen was significantly lower at 2 (8.5% ± 1.8%) and 5 minutes (9.5% ± 1.9%) than those after 7 minutes. Direct comparisons of slice-matched DHE area by MSCT demonstrated excellent correlation with TTC-derived infarct size (r = 0.952; P < .001). Bland-Altman plots of the differences between DHE by MSCT and TTC-derived infarct measurements plotted against their means showed good agreement between the 2 methods. CONCLUSION: The feasibility of myocardial viability assessment by DHE using MSCT after conventional ICA was proven in experimental models, and the optimal viability images were obtained after 2 to 5 minutes after the final intracoronary injection of contrast agent for conventional ICA.ope

Dapagliflozin attenuates diabetes-induced diastolic dysfunction and cardiac fibrosis by regulating SGK1 signaling

Background: Recent studies have reported improved diastolic function in patients administered sodium-glucose cotransporter 2 inhibitors (SGLT2i). We aimed to investigate the effect of dapagliflozin on left ventricular (LV) diastolic function in a diabetic animal model and to determine the molecular and cellular mechanisms underlying its function. Methods: A total of 30 male New Zealand white rabbits were randomized into control, diabetes, or diabetes+dapagliflozin groups (n = 10/per each group). Diabetes was induced by intravenous alloxan. Cardiac function was evaluated using echocardiography. Myocardial samples were obtained for histologic and molecular evaluation. For cellular evaluation, fibrosis-induced cardiomyoblast (H9C2) cells were obtained, and transfection was performed for mechanism analysis (serum and glucocorticoid-regulated kinase 1 (SGK1) signaling analysis). Results: The diabetes+dapagliflozin group showed attenuation of diastolic dysfunction compared with the diabetes group. Dapagliflozin inhibited myocardial fibrosis via inhibition of SGK1 and epithelial sodium channel (ENaC) protein, which was observed both in myocardial tissue and H9C2 cells. In addition, dapagliflozin showed an anti-inflammatory effect and ameliorated mitochondrial disruption. Inhibition of SGK1 expression by siRNA decreased and ENaC and Na+/H+ exchanger isoform 1 (NHE1) expression was confirmed as significantly reduced as siSGK1 in the diabetes+dapagliflozin group. Conclusions: Dapagliflozin attenuated left ventricular diastolic dysfunction and cardiac fibrosis via regulation of SGK1 signaling. Dapagliflozin also reduced macrophages and inflammatory proteins and ameliorated mitochondrial disruption.ope

Anti-Inflammatory Effect for Atherosclerosis Progression by Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor in a Normoglycemic Rabbit Model

Background and objectives: We sought to investigate an anti-atherosclerotic and anti-inflammatory effect of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in normoglycemic atherosclerotic rabbit model. Methods: Male New Zealand white rabbits (n=26) were fed with a 1% high-cholesterol diet for 7 weeks followed by normal diet for 2 weeks. After balloon catheter injury, the rabbits were administered with the Dapagliflozin (1mg/kg/day) or control-medium for 8 weeks (n=13 for each group). All lesions were assessed with angiography, optical coherence tomography (OCT), and histological assessment. Results: Atheroma burden (38.51±3.16% vs. 21.91±1.22%, p<0.01) and lipid accumulation (18.90±3.63% vs. 10.20±2.03%, p=0.047) was significantly decreased by SGLT-2 inhibitor treatment. The SGLT-2 inhibitor group showed lower macrophage infiltration (20.23±1.89% vs. 12.72±1.95%, p=0.01) as well as tumor necrosis factor (TNF)-α expression (31.17±4.40% vs. 19.47±2.10%, p=0.025). Relative area of inducible nitric oxide synthase⁺ macrophages was tended to be lower in the SGLT-2 inhibitor-treated group (1.00±0.16% vs. 0.71±0.10%, p=0.13), while relative proportion of Arg1⁺ macrophage was markedly increased (1.00±0.27% vs. 2.43±0.64%, p=0.04). As a result, progression of atherosclerosis was markedly attenuated in SGLT-2 inhibitor treated group (OCT area stenosis, 32.13±1.20% vs. 22.77±0.88%, p<0.01). Mechanistically, SGLT-2 treatment mitigated the inflammatory responses in macrophage. Especially, Toll-like receptor 4/nuclear factor-kappa B signaling pathway, and their downstream effectors such as interleukin-6 and TNF-α were markedly suppressed by SGLT-2 inhibitor treatment. Conclusions: These results together suggest that SGLT-2 inhibitor exerts an anti-atherosclerotic effect through favorable modulation of inflammatory response as well as macrophage characteristics in non-diabetic situation.ope

21세기 한국자본주의 대논쟁의 향후 발전 방향

우선 21세기 한국자본주의 대논쟁을 주제로 심포지움을 주최 한 서울대 경제연구소에 대하여 크게 축하하고, 특히 이근교수의 노고를 높이 평가한다. 그동안 우리 나라에서는 한국자본주의의 구조적 문제를 진보학자와 보수학자들이 함께 모여 진솔하게 토론하는 기회가 거의 없었다. 그래서 오늘의 모임이 특히 큰 의미를 가진다. 21세기 한국자본주의 대논쟁에 대하여 두 가지 코멘트를 하고자 한다. 첫 번째 의견은 다음과 같다. 우선 우리가 지금 한국의 자본주의 논쟁은 왜 하는가? 하는 문제이다. 답은 비교적 간단하지 않을까? 지금 우리나라 경제가 상당히 어렵다. 세계 다른 나라들과 함께 저성장과 양극화에 시달리고 있다. 따라서 한국자본주의 논쟁의 목적은 우선 우리 경제가 왜 저성장과 양극화에 시달리게 되었는가? 하는 문제의 근본적/핵심적 구조적 원인을 밝히고 한국경제의 살 길, 저성장과 양극화에서 벗어나는 길을 제시하고자 하는 데 두어야 한다고 생각한다. 그런데 오늘 발표 논문들을 보니 대체로 대기업과 중소기업 간의 동반성장의 문제 그리고 자본과 노동 간의 분배악화의 문제 등이 다수를 차지하고 있다. 그리고 대책으로는 초과이윤에 대한 과세와 자산소득에 대한 과세 문제 등이 집중적으로 논의되고 있다