Increased interleukin-11 and stress genes in human endothelial and human bronchial epithelial cell lines by silver nanoparticles

Graduate Program for Nanomedical Science/박사The ultrafine particle size of nanomaterials is limited to approximately 100 nm, and such a small size has allowed nanomaterials to be used in a variety of ways. Therefore, engineered nanoparticles are being used in various industries, including ceramics, polymers, smart textiles, pharmaceutical products, cosmetics, biomedicine, electronics, paints, chemicals, food, and environmental analysis. Metal nanoparticles that contain gold, silver, iron, zinc, and metal oxides are widely used for their large surface area to volume ratios and their unique physicochemical properties. In particular, silver NPs are in especially wide use in the medical field, where they are used in diagnosis and treatment and incorporated into medical devices and pharmaceuticals. Interestingly, however, silver NPs have been identified as a cause toxicity in the human body. Because of their small size, NPs that enter the human body can easily penetrate biological barriers and can be circulated throughout the entire body, ultimately reaching the vascular endothelium. With this in mind, the present study aimed to identify various cell responses by distinguishing between endothelial and epithelial cells and exposing them to silver nanoparticles (NPs). The study also worked to identify the progression of cell apoptosis that occurs as a result of intracellular oxidative stress caused by silver NPs and to determine which genes are being stimulated in order to cause such changes. We also assessed several gene expression levels that increased significantly in the microarray assay. We evaluated the cytotoxic effects of silver NPs both endothelial and epithelial cells. Although the LD50 of each cell line was estimated differently, we were able to prove the toxicity of silver NPs. Meanwhile, for 100 nm silver NPs, cell death was not observed in the high concentration group. We verified through microarray that 5 nm silver NPs affect the variation of gene expression in cells, and a noticeable increase in the expression of interleukin (IL)-8 and IL-11 genes in early time was also verified. This study found that the variation in oxidative stress-related genes in early time, and among them the variation of metallothionein (MT), heme oxygenase 1 (HO-1), and heat shock 70kDa protein (HSP70) expression, was noticeable. This study proves that HSP70, HO-1, and MT are sufficient as biomarkers of reactive oxygen species (ROS) and that the oxidative stress effect is greater as the size of NPs is smaller assuming that there is no variation in ROS related gene expression in 100 nm silver NPs. The microarray used in this study can analyze up to 24,838 RefSeq (Entrez) genes. Based on this analysis, genes undergoing intracellular change after exposure to silver NPs were classified into five categories: cell death, cell survival, inflammation, apoptosis, and ROS. As a result, there was considerable variation in genes related to cell death and apoptosis, and the expression of genes related to cell survival was also not negligible. Meanwhile, the number of genes related to inflammation was relatively small. Moreover, what is especially worth paying attention to is the increased IL-11 gene expression, which has not been much discussed in previous studies. In this study, the IL-11 gene expression particularly increased following the exposure of endothelial and epithelial cells to 5 nm silver nanoparticles. This study therefore verifies that IL-11 expression commonly increases in cells under the influence of silver NPs. In conclusion, this study finds that intracellular genes specifically respond to exposure to silver NPs and that the expression of IL-11 among cytokines is noticeable. It also finds that the toxic effect is affected by the size of NPs. However, this study verifies only that IL-11 expression increased, and thus further study would be required to elaborate on the various roles played by IL-11. 초미립자 나노물질의 크기는 약100 nm 정도로 이러한 작은 크기의 특성으로 인하여 산업적으로 여러 방면에서 활용이 되고 있다. 그...ope

Management of Complicated Intra-abdominal Infection - Two Cases

Compared to uncomplicated intra-abdominal infection (IAI), complicated IAI extend beyond the source organ and into the peritoneal cavity through the perforated bowel. Most of intra-abdominal infection encountered in the surgical field is secondary or tertiary peritonitis. In this article authors report management experiences of unusual two cases about complicated IAI; the first case is abdominal wall abscess accompanied by perforation of ascending colon perforation from traumatic mesentery injury, and the second case is about liver abscess followed by pleural empyema. In the first case, abdominal wall abscess was drained by ultrasonography-guided incision and drainage, and negative pressure wound therapy (NPWT) was applied on the soft tissue defect site. In the second case, right pleural empyema was formed after percutaneous liver abscess drainage, and thoracoscopy-assisted pleural decortications and drainage of pleural effusion were performed. For the treatment of complicated IAI, source control is the most important and proper empirical antibiotic and susceptible therapeutic antibiotics are also neededope

Prognostic Factors in Patients Who Performed Angiographic Embolization for the Bleeding from Injury of the Intraabdominal Organ and Pelvic Area.

PURPOSE: In patients with traumatic hemoperitoneum or pelvic bone fracture who underwent angiography and embolization, we want to find the prognostic factors related with mortality. METHODS: Patients(333 patients) who visited our hospital with traumatic injury from March 2008 to April 2012 were included in this study. Only 37 patients with traumatic hemoperitoneum or pelvic bone fracture underwent angiography and embolization. A retrospective review was conducted, and Glasgow coma scale (GCS), Revised trauma score (RTS), Injury severity score (ISS), initial laboratory finding and time interval, the amount of transfusion from the arrival at the ER to the start of embolization, and the vital signs before and after procedure were checked. Stastical analysis was conducted using the Chi square and Mann-Whitney U test. RESULTS: In univariate analysis, the amount of transfusion, the base deficit before procedure, the systolic blood pressure before and after the procedure, the GCS, the RTS and the ISS were significantly associated with prognosis. In the multivariate analysis, the ISS and the base deficit had significant association with prognosis. Of the 37 patients who underwent angiography and embolization, 31 patients needed not additional procedure (Group A) while the other 6 patients needed an additional procedure (Group B). After procedure, a statistically significant higher blood pressure was observed in Group A than in Group B. As to the difference in blood pressure before and after the procedure, a statistically significant decrease in systolic blood pressure was observed in Group B, but an increase was observed in Group A. CONCLUSION: In traumatic hemoperitoneum or pelvic bone fracture patients who underwent angiography and embolization, GCS, ISS, RTS, transfusion amount before the procedure, initial base deficit and systolic blood pressure were factors related to mortality. When patients who underwent angiography and embolization only were compared with patients who underwent re-embolization or additional procedure after the first embolization, an increase in systolic blood pressure after embolization was a prognostic factor for successful control of bleeding.ope

Correlation of the oxygen radical activity and antioxidants and severity in critically ill surgical patients – study protocol

BACKGROUND: Surgical patients who require an emergent operation commonly have severe sepsis or septic shock, followed by high morbidity and mortality rates.Despite advances in treatment however, no predictable markers are available. In severe sepsis, many pathophysiologic mechanisms are involved in progression to organ failure, and oxygen free radical and antioxidants are known to contribute to this process. Oxygen free radical and antioxidants contribute to progression of organ failure in severe sepsis. In fact, oxygen radical activity has been reported to be correlated with disease severity and prognosis in patients with severe sepsis or septic shock. Accordingly, we aim to assess the usefulness of oxygen free radical and antioxidant concentrations to predict the disease severity and mortality in a cohort of critically ill surgical patients. METHODS/DESIGN: This is a prospective observation study including patient demographic characteristics, clinical information, blood sampling/serum oxygen radical activity, serum antioxidant activity, serum antioxidant concentrations (zinc, selenium and glutamate), disease severity scores, outcomes, lengths of stay in intensive care unit, hospital 30-day mortality.ope

The choice of management in patients with splenic blunt trauma : a single center study

Purpose: Nowadays, non-operative management increases in patients with blunt splenic injury due to development of diagnostic and interventional technique. The purpose of this study is to evaluate the management in patients with blunt splenic injury and effect of clinical state such as shock on the choice of management. Methods: From April 2007 to July 2013, we retrospectively reviewed the medical charts of fifty patients who had splenic injury after blunt trauma. The demographic characteristics, American Association for the Surgery of Trauma (AAST) grade of splenic injury, management method (emergency operation, angiographic embolization or observation) and clinical outcome were analyzed. Results: The mean age was 41.5±21.4 years and male was 44(88%). Twenty patients(40%) were in shock condition initially and five patients(10%) underwent emergency operation due to hemodynamic instability. Emergency angiographic embolization was performed in 20 patients(40%) and 25 patients were managed conservatively. When patients were divided into shock group (SG) and non-shock group (NSG), Patients in SG had significantly higher serum lactate level and base deficit than NSG (lactate; 4.5±3.4 mmol/L, base deficit; 5.8± 4.4 mmol/L vs 1.9±1.4 mmol/L, 2.8±2.5 mmol/L, p=0.007, p=0.013). There was no significant difference of AAST grade and contrast blush rate in abdomen CT between two groups. Among 45 patients with non-operative management, four patients(8.9%) got delayed angiographic embolization and 3 patient died from companied organ injury. Conclusion: Non-operative management can be acceptable management option in patients with splenic blunt trauma under intensive hemodynamic monitoring.ope

A Case of Cardiac Laceration due to Anterior Thoracic Stab Injury

Among chest trauma patients, cardiac laceration is a rare, but severe, condition requiring prompt management. Depending on the patient’s hemodynamic status, early detection rate of a cardiac laceration may or may not be occur. If a possibility of cardiac laceration exists, an emergent thoracotomy should be performed. Furthermore, patients who experience a cardiac laceration also experience different kinds of complications. Therefore, close follow-up and monitoring are required. Herein, we report a 41-year-old man with a left atrium and a left ventricle laceration caused by a thoracic stab injury.ope

Development of a New Nutrition Screening Tool for Use in an Acute Care Hospital

Purpose: The objective of this study was to develop a new nutrition screening tool for quality improvement of the nutritional care process in an acute care hospital with a 2,000-bed capacity. Methods: To evaluate the current nutrition screening tool, we first examined 435 patients (274 men, aged 59.0±12.2 years). In the second step, the nutritional status of 387 patients (215 men, aged 57.5±13.3 years) was assessed by the scored patient-generated subjective global assessment (PG-SGA) tool. Variables such as age, body mass index (BMI), plasma albumin concentration, weight change, food intake change, and disease severity were analyzed to select indices for developing a new Severance nutrition screening index (SNSI). Results: The current nutrition screening tool had a poor correlation with the PG-SGA (κ=0.180, P＜0.0001). The SNSI was calculated as follows: SNSI = 1.5×albumin＋ 1.0×BMI＋4.5×intake change＋1.5×weight loss (for albumin＜ 3.0, BMI＜20, and decreased intake and weight loss＞5% of usual body weight). The SNSI showed a sensitivity of 90.5%, a specificity of 90.7%, and a high correlation (κ=0.628, P＜0.0001) with the PG-SGA. Conclusion: The SNSI appears to be a valid and useful nutrition screening tool to determine the nutritional risk of patients in acute care hospitals.ope

Selective Nonoperative Mangement of Traumatic Abdominal Injury

In traumatic hemoperitoneum, surgical intervention is the mainstay of the treatment. Especially patients who are hemodynamically unstable or having peritoneal irritation signs should undergo emergency laparotomy. However, according to the recent advance of the imaging and interventional techniques, nonoperative management for abdominal trauma is widely spreading. We review the nonoperative management of the abdominal trauma based on the recent literature and guidelines.ope

Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis

Background Many studies have shown that serum albumin and prealbumin levels correlate with patient outcomes in critically ill patients. The purpose of this study was to evaluate the clinical significance of prealbumin and albumin levels in patients in the intensive care unit (ICU) after emergency surgery for acute peritonitis. Methods We examined serum albumin and prealbumin as markers for the prediction of patient outcome in 51 patients admitted to the ICU after emergency surgery from January to December in 2012. Biochemical parameters were measured postoperatively. Serum albumin and prealbumin levels were compared between survivors and non-survivors. Patients were also divided according to the occurrence of shock and pulmonary complications (shock group vs. non-shock group, pulmonary complications group vs. non-pulmonary complications group), and outcome analysis was performed for age, American Society of Anesthesiologists (ASA) score, length of ICU stay (IS), length of hospital stay (HS), mechanical ventilation, and APACHE II score. Serum albumin and prealbumin levels were evaluated for any correlation with complications and mortality. Results In patients with shock, prealbumin and albumin were significantly decreased (p = 0.047, p = 0.036). Additionally, albumin was significantly decreased in patients with pulmonary complications. Neither albumin nor prealbumin, however, showed a correlation with mortality. Prealbumin showed a correlation with serum albumin, CRP level, and HS (r = 0.511, p < 0.001; r = -0.438, p = 0.002; and r = -0.45, p = 0.001, respectively). Albumin showed a correlation with HS, IS, and APACHE II score (r = -0.404, p = 0.003; r = -0.424, p = 0.002; and r = -0.40, p = 0.006, respectively). Conclusions The initial prealbumin level measured upon admission to the ICU after gastrointestinal emergency surgery can be useful predictor of shock. The initial albumin level was significantly low in patients with shock and pulmonary complications. However, neither prealbumin nor albumin showed a correlation with mortality. Our study also showed that albumin and prealbumin levels are affected by other factors, such as massive hydration and severe inflammation, as reported in previous studies.ope

Definition and Pathophysiologic Mechanisms of the Sepsis

Sepsis is the overwhelming disease resulting serious outcome, and has the high morbidity and mortality rate. In surgical patient, many of them have septic condition, and consist of 8% of critically ill surgical patients. And postoperative sepsis is common complications result in 24∼44% of mortality. Understanding of definitions and pathophysiologic mechanisms of the sepsis is the mainstay to treat and manage the septic patient. In this section, we describe the definitions and pathophysiologic mechanisms of the sepsis, brieflyope