Comparison of differences in ventilation volume according to fixation method of I-gel during cardiopulmonary resuscitation in hospital: a study using a simulation manikin

Objective@#The I-gel device and endotracheal tube are used for advanced airway management during cardiopulmonary resuscitation (CPR). This study compares differences in the ventilation volume according to the fixation methods (tape and band) of I-gel using a simulation manikin. @*Methods@#I-gel was placed in an advanced life support simulator and fixed with either tape or band fixation, and an endotracheal tube was inserted using an endotracheal tube holder (AnchorFast). CPR was performed according to the 2020 Korean CPR guidelines, using a mechanical chest compression device (LUCAS) and an adult bag. CPR was performed for 30 minutes. Positional shifts of the I-gel and endotracheal tube and differences in the ventilation volume on the simulation manikin were subsequently measured. Five trials were carried out in each setting. Statistical analysis was carried out using SPSS version 27.0. A P-value <0.05 is considered significant. @*Results@#The following positional shifts were obtained after 30 minutes of CPR: I-gel tape fixation, 4.96±0.72 mm; I-gel band fixation, no change; endotracheal tube holder, no change. The mean ventilation volumes obtained were 504.43± 14.42, 536.86±5.56, and 528.38±8.81 mL, respectively. @*Conclusion@#Our results indicate that the use of I-gel is as effective as an endotracheal tube for initial airway maintenance during CPR in the hospital. We recommend using an elastic band-type fixation device for the fixation method.

Spatiotemporal Analysis of Event-related Current Density Reveals Dissociable Effects of Arousal and Valence on Emotional Picture Processing

BACKGROUND: The processing of emotional visual stimulation involves the processing of emotional and visuoperceptual information. It is not completely revealed how the valence and arousal affect these two aspects. The objective was to investigate the effects of valence and arousal on spatiotemporal characteristics of cortical information processing using distributed source imaging of event-related current density (ERCD). METHODS: Electroencephalograms (64 channels) were recorded from 19 healthy men while presenting affective pictures. Distributed source localization analysis was adopted to obtain the spatiotemporal pattern of ERCD on cortical surface in response to emotional visual stimulation. A nonparametric cluster-based permutation test was used to find meaningful time and space without prior knowledge. RESULTS: Significant changes of ERCD in 400–800 ms among positive, negative, and neutral emotional conditions were found in left posterior cingulate cortex (PCC) and right inferior temporal cortex (ITC). In the PCC, the stimuli with higher arousal levels showed more negative ERCD than neutral stimuli. In the ITC, the ERCD for negative stimuli was significantly more negative than those of positive and neutral ones. CONCLUSION: Arousal and valence had strong influence on memory encoding and visual analysis at late period. The location and time showing significant change in neural activity according to arousal and valence would provide valuable information for understanding the changes of cortical function by neuropsychiatric disorders.

Amplitude Modulation-based Electrical Stimulation for Encoding Multipixel Spatiotemporal Visual Information in Retinal Neural Activities

Retinal implants have been developed as a promising way to restore partial vision for the blind. The observation and analysis of neural activities can offer valuable insights for successful prosthetic electrical stimulation. Retinal ganglion cell (RGC) activities have been investigated to provide knowledge on the requirements for electrical stimulation, such as threshold current and the effect of stimulation waveforms. To develop a detailed ‘stimulation strategy’ for faithful delivery of spatiotemporal visual information to the brain, it is essential to examine both the temporal and spatial characteristics of RGC responses, whereas previous studies were mainly focused on one or the other. In this study, we investigate whether the spatiotemporal visual information can be decoded from the RGC network activity evoked by patterned electrical stimulation. Along with a thorough characterization of spatial spreading of stimulation current and temporal information encoding, we demonstrated that multipixel spatiotemporal visual information can be accurately decoded from the population activities of RGCs stimulated by amplitude-modulated pulse trains. We also found that the details of stimulation, such as pulse amplitude range and pulse rate, were crucial for accurate decoding. Overall, the results suggest that useful visual function may be restored by amplitude modulation-based retinal stimulation.

Abnormal Sleep Delta Rhythm and Interregional Phase Synchrony in Patients with Restless Legs Syndrome and Their Reversal by Dopamine Agonist Treatment

BACKGROUND AND PURPOSE: The purpose of this study was to characterize abnormal cortical activity during sleep in restless legs syndrome (RLS) patients and to determine the effects of treatment with a dopamine agonist. Based on whole-brain electroencephalograms, we attempted to verify alterations in the functional network as well as the spectral power of neural activities during sleep in RLS patients and to determine whether the changes are reversed by treatment with pramipexole. METHODS: Twelve drug-naïve RLS patients participated in the study. Overnight polysomnography was performed before and after treatment: the first recording was made immediately prior to administering the first dose of pramipexole, and the second recording was made 12–16 weeks after commencing pramipexole administration. Sixteen age-matched healthy participants served as a control group. The spectral power and interregional phase synchrony were analyzed in 30-s epochs. The functional characteristics of the cortical network were quantified using graph-theory measures. RESULTS: The delta-band power was significantly increased and the small-world network characteristics in the delta band were disrupted in RLS patients compared to the healthy controls. These abnormalities were successfully treated by dopaminergic medication. The delta-band power was significantly correlated with the RLS severity score in the RLS patients prior to treatment. CONCLUSIONS: Our findings suggest that the spectral and functional network characteristics of neural activities during sleep become abnormal in RLS patients, and these abnormalities can be successfully treated by a dopamine agonist.

Signature Genes in Macrodactyly through Transcriptome Network Analysis Reveal their Association of Lipid Metabolism / 체질인류학회지

Macrodactyly is one of the most difficult hand anomalies to treat not only surgically but medically as well. Little is known about the molecular pathways and lipid metabolism of this disease. To elucidate the potential mechanism of macrodactyly progress, we used the bioinformatical analysis including quantile normalization, principal component analysis, heatmap and volcano plot. For the functional bioinformatical study, lipid, lipoprotein and phospholipid metabolism of Kyoto Encyclopedia of Genes and Genomes, Wiki Pathways, and Reactome Pathway were utilized to compare the differentially expressed genes in macrodactyly with control group. We found up-regulation of CDK6 and E2F1, which are associated with the mitotic cell cycle of cancer cells. PIK3CG, associated with cancer and lipid metabolism, was also enriched in macrodactyly. In down-regulated genes, PTEN was highlighted in lipid metabolism, phosphatidylinositol signaling system and insulin signaling. ABCD3, related in peroxisomal import of fatty acids, was also down-regulated. In this study, we predicted the pathogenic candidate genes as well as the potential molecular pathways related to macrodactyly by identifying the signature genes. Signature genes through systems bioinformatical analysis can be utilized to catch the insight of the molecular pathogenesis of macrodactyly.

Comparative Analyses of Signature Genes in Acute Rejection and Operational Tolerance

Using biomarkers as prediction tools or therapeutic targets can be a valuable strategy in transplantation. Recent studies identified biomarkers of acute rejection (AR) and operational tolerance (TOL) through the application of meta-analysis. In this study, we comparatively analyzed the signature genes in acute rejection and operational tolerance seen in human allogeneic transplantations using massive bioinformatical meta-analysis. To identify the signature genes in opposite immunological conditions, AR and TOL, we first collected the 1,252 gene expression data specifically intended for those circumstances. Then we excluded based on biological cut-values, Principal Component Analysis (PCA) as well as Multi-Dimensional Scaling (MDS). Using differentially expressed genes (DEGs) from meta-analysis, we then applied a ranked scoring system to identify the signature genes of AR and TOL. We identified 53 up-regulated and 32 down-regulated signature genes in acute rejection condition. Among them, ISG20, CXCL9, CXCL10, CCL19, FCER1G, PMSE1, UBD are highly expressed in AR condition. In operational tolerance, we identified 110 up-regulated and 48 down-regulated signature genes. TCL1A, BLNK, MS4A1, EBF1, IGHM are up-regulated in TOL condition. These genes are highly representative of AR or TOL across the different organs such as liver, kidney and heart. Since immune response is the sum of complex biological and molecular dynamics, these signature genes as well as pathway analysis using a systems biology approach could be used to catch the insights of the certain pathways that would be overlooked with the conventional gene-level comparative analysis.

A Delphi Study on Charging for 119 Emergency Medical Services

PURPOSE: This study was performed to suggest a realistic measure of charging for 119 emergency medical services (EMS) in Korea using Delphi study targeting emergency medical specialists. METHODS: The Delphi study was conducted four times targeting 24 emergency medical specialists. The first Delphi survey contained five categories as follows: Subjects of charging for 119 EMS, method of charging, strategy of implementation, utilization of fund, measure of quality improvement. In the second and third Delphi surveys, respondents were asked to indicate the level of importance with the questionnaire statements on a Likert scale, ranging from 0 to 5. The final consultation survey collected opinions on the system of charging for 119 EMS. RESULTS: The results from the first three Delphi surveys showed subjects of charging, method of charging, strategy of implementation, utilization of fund, and measure of quality improvement for 119 EMS. The fourth Delphi survey resulted in step 1 (classification of severity), step 2 (scene of accident), and step 3 (classification of severity at hospital). The classification of severity in steps 1 and 2 should be evaluated by first grade emergency medical technicians, and the classification of severity in step 3 should be evaluated by a person notified by the Ministry of Health and Welfare. Non-emergent patients should pay for the charge of 119 EMS to the hospital. CONCLUSION: Delphi study proposed charging for 119 EMS based on three levels of severity. This study suggests that charging for EMS can reduce unnecessary emergency calls and offer proper medical services to emergency patients.

A case of severe corrosive esophagitis, gastritis, and liver necrosis caused by ingestion of methyl ethyl ketone peroxide

The plastic hardener methyl ethyl ketone peroxide is unstable peroxide that releases free oxygen radicals. Ingestion of this compound induces widespread liver necrosis, severe metabolic acidosis, corrosive esophagitis and gastritis, that is often fatal. A 49-year-old man unintentionally ingested approximately 100 mL (55%) of this compound in solution, which was purchased as plastic hardener. Despite resuscitation, he died about 11 hours after admission. We report a patient with poisoning due to methyl ethyl ketone peroxide who presented with corrosive esophagitis and gastritis, gastrointestinal bleeding, and developed ischemia of the bowel and necrosis of the liver and died of severe metabolic acidosis and multiorgan failure.

Superior Mesenteric Artery Syndrome Treated with Percutaneous Radiologic Gastrojejunostomy / 대한소화기학회지

Superior mesenteric artery (SMA) syndrome is a rare condition that must be differentiated from other gastrointestinal diseases manifesting as upper abdominal pain, nausea, or vomiting. The description of SMA syndrome is compression of the third portion of the duodenum by the SMA and the abdominal aorta. SMA syndrome is managed with nasoenteral nutrition or surgical strategies such as laparoscopic duodenojejunostomy. However, SMA syndrome treated using enteral nutrition by percutaneous radiologic gastrojejunostomy has not been reported. Here, we report our experience of successfully managing a case of SMA syndrome with percutaneous radiologic gastrojejunostomy.

A Case of Sepsis Associated with Klebsiella pneumoniae Colitis in an Immunocompetent Adult

A 47-year-old female patient was admission for back pain after she fell down on the table. T12 compression fracture was found for spinal magnetic resonance imaging. Absolute bed rest and pain control for non-steroidal anti-inflammatory drugs and muscle relaxant were received. After 7 days, she complained febrile sense, abdominal pain, and diarrhea. Septic shock was suspected, and then use of antibiotics and proper management were performed. Computed tomography of chest and abdomen was not revealed specific finding. Blood culture showed growth of Klebsiella pneumoniae. After patients completely resolved symptoms, colonoscopy was performed that showed erosive lesions of cecum, proximal A-colon, and rectum.

A Case of Ischemic Gastric Necrosis after Epinephrine Injection in a Patient with Anemia / 대한내과학회지

Endoscopic epinephrine injection is a safe and easy treatment for non-variceal gastrointestinal bleeding. It has low complication rates and is used widely. Ischemic gastric necrosis occurs rarely because of the rich vascular supply of the stomach and the vascular reserve of the intramural anastomosis. Endoscopic injection therapy, smoking, hypertension, and atherosclerosis are risk factors for gastric ischemia. There have been a few case reports of gastric ischemia after endoscopic injection therapy. We report a case of gastric ischemia after submucosal epinephrine injection in a 29-year-old woman with anemia.

A Large Polypoid Vascular Ectasia Removed by Using a Polypectomy With a Detachable Snare in an Asymptomatic Patient

Vascular ectasia is a well-known cause of lower gastrointestinal bleeding in the elderly. Endoscopically, it usually appears as a flat or elevated bright red lesion. We report on an extremely rare case of a large, pedunculated, polypoid vascular ectasia in an asymptomatic patient. A large pedunculated polypoid mass in the sigmoid colon was observed on colonoscopy during a regular health check-up, and a polypectomy was performed using a detachable snare. In histology, vessels with massive dilation were found mainly in the submucosa, which was consistent with vascular ectasia.

Specific Protein Markers for Stem Cell Cross-Talk with Neighboring Cells in the Environment

A stem cell interacts with the neighboring cells in its environment. To maintain a living organism's metabolism, either cell-cell or cell-environment interactions may be significant. Usually, these cells communicate with each other through biological signaling by interactive behaviors of primary proteins or complementary chemicals. The signaling intermediates offer the stem cell's functionality on its metabolism. With the rapid advent of omics technologies, various specific markers by which stem cells cooperate with their surroundings have been discovered and established. In this article, we review several stem cell markers used to communicate with either cancer or immune cells in the human body.

Insertion of Self Expandable Metal Stent for Malignant Stomal Obstruction in a Patient with Advanced Colon Cancer

Self expandable metal stent can be used both as palliative treatment for malignant colorectal obstruction and as a bridge to surgery in patients with potentially resectable colorectal cancer. Here, we report a case of successful relief of malignant stomal obstruction using a metal stent. A 56-year-old man underwent loop ileostomy and was given palliative chemotherapy for ascending colon cancer with peritoneal carcinomatosis. Eight months after the surgery, he complained of abdominal pain and decreased fecal output. Computed tomography and endoscopy revealed malignant stomal obstruction. Due to his poor clinical condition, we inserted the stent at the stomal orifice, instead of additional surgery, and his obstructive symptoms were successfully relieved. Stent insertion is thought to be a good alternative treatment for malignant stomal obstruction, instead of surgery.

Jejunal Metastasis of Lung Cancer Diagnosed with Double Balloon Enteroscopy / 대한소화기내시경학회지

Metastasis from lung cancer to the small bowel is rare and this accounts for 0.2% to 0.5% of all the cases of metastasis from lung cancer. In most cases, the patients are asymptomatic and they can show signs of bleeding, intestinal obstruction, perforation and so on. A better diagnostic approach to the small bowel has recently been made possible through capsule endoscopy and double balloon enteroscopy (DBE), and they have a higher diagnostic rate for small bowel bleeding compared with that of the previous diagnostic tests. DBE makes it possible to diagnose precisely due to the high quality endoscopic images and biopsy specimens. In addition, therapeutic DBE with a 2.8 mm channel enables performing more kinds of therapeutic procedures than diagnostic DBE with a 2.2 mm channel. If small bowel metastasis is suspected on 18FDG-PET/CT, then DBE can be considered for making a pathologic diagnosis. We report here on a case of small bowel metastasis from non small cell lung cancer in a 39-year-old woman who complained of hematochezia and we review the relevant literature.

A Case of Endoscopically Treated Jejunal Bleeding from Polyarteritis Nodosa / 대한소화기내시경학회지

Polyarteritis nodosa is a necrotizing vasculitis of the small and medium-sized arteries of multiple organ systems. The common symptoms of gastrointestinal involvement are abdominal pain, nausea, and vomiting. However, the symptoms at presentation are sometimes non-specific and vague. The well-known complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. We describe a case of a 6-year-old male with jejunal bleeding who was diagnosed with polyarteritis nodosa by angiography. After controlling the systemic symptoms with immunosuppressants and steroids, jejunal bleeding occurred. The jejunal bleeding was treated endoscopically with a hemoclip and increasing the immunosuppressant dose. Generally, massive gastrointestinal bleeding in a patient with polyarteritis nodosa is treated surgically. In this case, the jejunal bleeding was controlled with an endoscope because the bleeding site was located within reach of the endoscope, and systemic symptoms subsided with medication. There is no report of gastrointestinal bleeding from the polyarteritis nodosa in a child in Korea. Therefore, we report this case with a review of the relevant literature.

Plasma Neuron-specific Enolase and Glutamic Acid Level in Acute Ischemic Stroke

PURPOSE: We studied the plasma neuron-specific enolase (NSE) and glutamic acid levels as a marker of the severity of acute ischemic stroke (AIS). METHODS: We enrolled 93 patients who visited to the emergency department from April to September, 2005. The AIS patients included those who visited the emergency department within 24 hours due to ischemic stroke symptoms. The AIS patients was subclassified according to large-vessel, small-vessel, cardioembolic, or unclassified infarction. RESULTS: The plasma NSE and glutamic acid level were 15.1+/-7.9 ng/ml and 204.5+/-86.5 nM/ml, respectively, in the AIS patients. Plasma NSE and Glutamic acid in the was higher than reference range (NSE 0-12 ng/ml, Glutamic acid 0-130 nM/ml). According to the type of infarction, no differences were observed in the plasma NSE and glutamic acid levels. CONCLUSION: In cases of AIS, NSE and glutamic acid have no statistical usefulness in classifying the type of infarction. However, the value of plasma NSE and glutamic acid levels have statistical usefulness in deciding on the existence or nonexistence of an AIS.

Effect of Low Dose 5-Fluorouracil and Cisplatin Intra-arterial Infusion Chemotherapy in Advanced Hepatocellular Carcinoma with Decompensated Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) has a poor prognosis. The aim of this study was to evaluate the efficacy and safety of repeated arterial infusions of low dose cisplatin and 5-fluorouracil (FU) in patients with advanced HCC with decompensated cirrhosis. METHODS: Between January 1995 and December 2003, a total of 79 decompensated cirrhotic patients having HCC and PVT were enrolled and divided into 2 groups. Group 1 (n=40) received intra-arterial infusion chemotherapy with cisplatin (10 mg for 5 days) and 5-FU (250 mg for 5 days) via an implanted chemoport every 4 weeks' and group 2 (n=39) was managed with only conservative treatment. RESULTS: The two groups were well matched with respect to the features relating to the prognosis, including age, gender and the Child- Pugh class. Although diffuse tumor involvement, main portal vein tumor thrombosis and bi-lobar involvement were more frequent in group 1, the median survival period of group 1 was significantly longer than group 2 (5 months vs. 3 months, respectively, P=0.016). Also, the 1-year survival rate of group 1 (7.5%) was higher than that of group 2 (5.1%) (P=0.016). When we analyzed the patients with the Child class B, the survival benefits of intra-arterial chemotherapy were more significant (P=0.008). CONCLUSIONS: Intra-arterial chemotherapy consisting of low dose 5-FU and cisplatin achieved favorable results for advanced HCC patients who had decompensated cirrhosis, and it showed better survival in selected patients. This therapy may be useful as a palliative treatment for HCC patients with decompensated cirrhosis.

A Case of Salmonella Liver Abscess / 대한소화기학회지

Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.

Immunohistochemical Study for Expression of cFos, pERK1/2 and pAkt Proteins in a Macrosphere Animal Model for Permanent Focal Brain Ischemic Injury

PURPOSE: Recently, a new animal model for permanent focal brain ischemia using macrospheres was developed wherein the hypothalamic area was free from ischemic injury. The purpose of this study was to evaluate spatiotemporal changes in the expressions of cFos, pERK, and pAkt proteins in the macrosphere model. METHOD: Three or four macrospheres were injected into the internal carotid artery after ligation of the external carotid artery to induce permanent focal brain ischemic injury. RESULT: Twenty-four hours after macrosphere injection, 2,3,5-Triphenyltetrazlium (TTC) staining showed a marked ischemic injury in the blood supply territory of the middle cerebral artery, for example, the cerebral cortex and striatum. Furthermore, TUNEL staining revealed apoptotic cell death in the ischemic injury region of the cerebral cortex and striatum. Expression of the cFos protein was significant in the penumbral zone, but not in the ischemic core of the cortex and striatum, two and six hours after ischemic insult. A transient prominent expression of the pERK1/2 protein was noted in the penumbral zone of the cortex and striatum two hours after injection of macrospheres. In contrast, there was a strong immunoreactivity for the pAkt protein in the ischemic core, but not in the penumbral zone of the cortex and striatum, six hours after ischemic injury. CONCLUSION: The above results suggest that early expressions of cFos, pERK1/2, and pAkt proteins take part in different signaling cascades for cell survival or death in macrosphere animal model of permanent focal brain ischemic injury.