Hepatocyte growth factor and soluble cMet levels in plasma are prognostic biomarkers of mortality in patients with severe acute kidney injury

Background@#Hepatocyte growth factor (HGF)/cMet pathway is necessary for repair and regeneration following acute kidney injury (AKI). We evaluated the clinical potential of plasma HGF and soluble cMet as prognostic biomarkers for severe AKI requiring continuous renal replacement therapy (CRRT). @*Methods@#One hundred thirty-six patients with severe AKI who participated in the VENUS (volume management under body composition monitoring in critically ill patients on CRRT) trial between 2017 and 2019 were enrolled in this study. We investigated associations between plasma HGF and cMet concentrations and all-cause mortality. @*Results@#Plasma HGF and soluble cMet levels were positively correlated. Patients were divided into three groups based on their HGF and soluble cMet concentrations. The day D 0, D2, and D7 highest concentration HGF groups had significantly higher in-hospital mortality after adjusting for sex, body mass index, Acute Physiology and Chronic Health Evaluation II, and age-adjusted Charlson comorbidity index score, especially on D7 (hazard ratio, 4.26; 95% confidence interval, 1.71–10.62; p = 0.002). D7 soluble cMet level was also associated with mortality. Receiver operating characteristic curve analysis indicated that D7 HGF and soluble cMet levels were best at predicting mortality. Addition of plasma HGF and soluble cMet to conventional prognostic indices significantly improved the predictive value for mortality on D7. However, plasma HGF and soluble cMet were not associated with fluid status. @*Conclusion@#Plasma HGF and soluble cMet levels were significant predictors of the outcomes of severe AKI patients undergoing CRRT. There was no correlation between plasma HGF and soluble cMet levels and fluid balance.

Emergency medicine residents' and medical students' perspectives about emergency medicine professionalism

OBJECTIVE: This study investigated and compared the perspectives on emergency medicine (EM) professionalism competencies of medical students and EM residents. In addition, how they learned their EM professionalism was also investigated to develop the base of an educational program of professionalism in the field of EM. METHODS: Medical students in four medical colleges/schools and EM residents were recruited for the questionnaire. Regarding the importance and educational need for EM professionalism, 23 items for medical students and 59 items for EM residents were asked. The items were rated on a five point Likert scale. The perspectives of the two groups were compared. The learning methods for professionalism were investigated. RESULTS: A total of 198 medical students and 109 EM residents responded to the questionnaire. The residents responded with mean of 3.0 or more on all items, agreeing on the importance and educational need. On the other hand, the mean scale was less than 4.0 in communication and cooperation with society and social accountability. The students responded with a mean scale of 4.0 or more on all items and agreed on the importance and educational need. Of the 23 common items, there were differences between the two groups in 17 items, showing a higher mean value in the students. The most common methods of learning EM professionalism was bedside teaching during the clinical clerkship for students, and patient handover or board round for residents. CONCLUSION: EM residents tended to place more importance on medical care than social communication, cooperation, and ethical items. The most common learning method of EM professionalism was clinical practice-associated activities. The results of this study could help to develop a systematic and realistic educational program of EM professionalism in EM clerkship and resident training.

Active maintenance of endothelial cells prevents kidney fibrosis

BACKGROUND: Soluble epoxide hydrolase (sEH) expressed by endothelial cells catalyzes the metabolism of epoxyeicosatrienoic acids (EETs), which are vasoactive agents. METHODS: We used a unilateral ureteral obstruction mouse model of kidney fibrosis to determine whether inhibition of sEH activity reduces fibrosis, the final common pathway for chronic kidney disease. RESULTS: sEH activity was inhibited by continuous release of the inhibitor 12-(3-adamantan-1-ylureido)-dodecanoic acid (AUDA) for 1 or 2 weeks. Treatment with AUDA significantly ameliorated tubulointerstitial fibrosis by reducing fibroblast mobilization and enhancing endothelial cell activity. In an in vitro model of endothelial-to-mesenchymal transition (EndMT) using human vascular endothelial cells (HUVECs), AUDA prevented the morphologic changes associated with EndMT and reduced expression of fibroblast-specific protein 1. Furthermore, HUVECs activated by AUDA prevented the epithelial-to-mesenchymal transition (EMT) of tubular epithelial cells in a co-culture system. CONCLUSION: Our findings suggest that regulation of sEH is a potential target for therapies aimed at delaying the progression of kidney fibrosis by inhibiting EndMT and EMT.

Active maintenance of endothelial cells prevents kidney fibrosis

BACKGROUND: Soluble epoxide hydrolase (sEH) expressed by endothelial cells catalyzes the metabolism of epoxyeicosatrienoic acids (EETs), which are vasoactive agents. METHODS: We used a unilateral ureteral obstruction mouse model of kidney fibrosis to determine whether inhibition of sEH activity reduces fibrosis, the final common pathway for chronic kidney disease. RESULTS: sEH activity was inhibited by continuous release of the inhibitor 12-(3-adamantan-1-ylureido)-dodecanoic acid (AUDA) for 1 or 2 weeks. Treatment with AUDA significantly ameliorated tubulointerstitial fibrosis by reducing fibroblast mobilization and enhancing endothelial cell activity. In an in vitro model of endothelial-to-mesenchymal transition (EndMT) using human vascular endothelial cells (HUVECs), AUDA prevented the morphologic changes associated with EndMT and reduced expression of fibroblast-specific protein 1. Furthermore, HUVECs activated by AUDA prevented the epithelial-to-mesenchymal transition (EMT) of tubular epithelial cells in a co-culture system. CONCLUSION: Our findings suggest that regulation of sEH is a potential target for therapies aimed at delaying the progression of kidney fibrosis by inhibiting EndMT and EMT.

In Vitro Effects of Nitroglycerin, Nicardipine, Verapamil, and Papaverine on Rabbit Brachial and Celiac Arterial Tone / 대한흉부외과학회지

BACKGROUND: Vasoconstrictor-induced reduction in arterial graft diameter can cause significant flow deprivation. The aim of this study was to evaluate the effect of vasodilator pretreatment on vasoconstrictor-induced blood vessel spasm in vitro. MATERIAL AND METHOD: Rabbit brachial arteries (BA) and celiac arteries (CA) were cut into rings (3~4 mm) and suspended with a force displacement transducer (TSD 125C(R), Biopac Inc. USA) in a tissue bath filled with 5 mL modified Krebs solution bubbled with 5% CO2 and 95% O2 at 38degrees C. The rings were contracted with vasoconstrictors, and the developed tension changes were considered control values. The rings were then pretreated with 30micrometer nitroglycerin, nicardipine, verapamil, and papaverine, respectively, for 40 minutes and rinsed with the physiologic buffered salt solution three times every 15 min. The vasoconstrictor-induced tension changes after the previous procedure were considered experimental values. Data are expressed as the percentage tension induced by vasoconstrictors before and after pretreatment with vasodilators. RESULT: Nicardipine depressed vasoconstriction induced by norepinephrine, angiotensin II (AII), and U46619 in both the BA and the CA more significantly than did nitroglycerin (p<0.01) and verapamil (p<0.05). Verapamil depressed vasoconstriction induced by 5-hydroxytryptamine (5HT), AII, and U46619 in the BA and by 5HT in the CA more significantly than did nitroglycerin (p<0.01). CONCLUSION: These findings suggest that both nicardipine and verapamil effectively depressed vasoconstrictor action. Nicardipine is thought to be more effective than verapamil for the prevention of vasoconstrictor action.

The Incidence and Clinical Significance of Paraneoplastic Syndromes in Patients with Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Patients with hepatocellular carcinoma (HCC) may manifest paraneoplastic syndromes such as hypercholesterolemia, hypoglycemia, hypercalcemia and erythrocytosis. This study was aimed at evaluating the incidence and clinical significance of paraneoplastic syndromes in Korean HCC patients. METHODS: The medical records of 165 HCC patients who were diagnosed and died in the Kyung Hee University Hospital, were reviewed retrospectively. The following variables were analyzed: age, gender, hepatitis markers, platelet, liver function test, alpha-fetoprotein (AFP), Child-Pugh score, tumor features, and the duration of their survival. RESULTS: In total, paraneoplastic syndromes were presented in 43.6% of the HCC patients during the course of their disease. Hypercholesterolemia was solely presented in 14.5%, hypoglycemia in 12.7% and hypercalcemia in 7.8%. The patients who presented with more than 2 syndromes were 8.5%. While 80% of erythrocytosis (4/5) and 51.6% of hypercholesterolemia (16/31) was presented at the time of HCC diagnosis, hypoglycemia and hypercalcemia mainly occurred as terminal events. The patients with paraneoplastic syndromes were younger and had higher rates of portal vein thrombosis, bi-lobar tumor involvement and tumor more of more than 10 cm in diameter, compared to those patients without them. The proportion of patients with a serum AFP more than 400 ng/mL tended to be higher in the patients with paraneoplastic syndromes. The HCC patients with paraneoplastic syndromes, except for erythrocytosis, had a shorter survival than those patients without them. CONCLUSIONS: Paraneoplastic syndromes are not infrequently presented in HCC patients, especially at an advanced stage, and the survival of these patients is relatively shorter.

A Case of Thrombotic Thrombocytopenic Purpura Associated with Acute Myocardial Infarction

Thrombotic thrombocytopenic purpura (TTP) is an unusual syndrome characterized by a clinical picture of micro-angiopathic hemolytic anemia, thrombocytopenic purpura, neurologic symptoms, renal disease and fever. Although widespread vascular thrombosis is common in TTP, the evidence of cardiac involvement is less clear. We report the first Korean case of a 22-year-old woman with TTP associated with acute myocardial infarction. With continued plasmapheresis, the clinical status of TTP improved markedly and was stabilized. Serial echocardiograms showed improvement of the cardiac wall motion.

A Case of Mitral Regurgitation due to Windsock Deformity with Perforations of the Anterior Mitral Leaflet-a Late Complication of Endocarditis

A valvular perforation is a well-known, and common, complication of infective endocarditis that may adversely affect the clinical outcome. However, a 'windsock' deformity of the mitral valve, as a delayed presentation of infective endocarditis, affecting the mitral valve alone, is very rare. A 42-year-old man, who underwent a mitral valvuloplasty and annuloplasty six years previously, suddenly developed pulmonary edema. He had also had a previous history of infective endocarditis, dating back three years. A transthoracic echocardiogram revealed a 'windsock' deformity of the anterior mitral leaflet (AML), resulting in an acute severe mitral regurgitation. During the operation, the AML was found to have been damaged by the previous endocarditis, resulting in an aneurysmal change of the central scallop, and a rupture of the roof. A mitral valve replacement was successfully performed, and the patient recovered uneventfully. Here, we report a rare case of a 'windsock' deformity of the mitral valve, with two perforations as a delayed complication of a healed infective endocarditis.

A Giant Cystic Mediastinal Tuberculosis Communicating with Pericardium / 결핵

We report a very rare case of mediastinal tuberculosis in a 57-year old woman who presented with a large mediastinal cyst on chest radiography. She had a 10-year history of exertional dyspnea, but felt comfortable at a rest. A subsequent chest CT suggested a mediastinal cyst with mediastinal lymphadenopathy and communicating pericardial sac. She underwent a thoracotomy and excision of the mass, which was histologically revealed to be of tuberculous origin. Although rare, the apparent increase in the incidence of tuberculosis may result mediastinal cysts being diagnosed mediastinal tuberculosis. We also briefly review mediastinal lymphadenopathy due to tuberculosis.

Effect of local background intensities in the normalization of cDNA microarray data with a skewed expression profiles

Normalization of the data of cDNA microarray is an obligatory step during microarray experiments due to the relatively frequent non-specific errors. Generally, normalization of microarray data is based on the null hypothesis and variance model. In the Yang's model (Yang et al., 2001), at least two types of noises are included. The one is additive noise and the other is multiplicative noise. Usually, background is considered as one of additive noise to the signal and the variation between the signal pixels is the representative multiplicative noise. In this study, the relation between the signal (spot intensity minus background intensity) and background was observed and the influence of background on normalization as a representative additive factor was investigated. Although the relation has not been considered as a factor affecting the normalization, it could improve the accuracy of microarray data when the normalization was carried out considering signal/background ratio. The background dependent normalization decreased the number of genes whose expression levels were changed significantly and it could make their distribution more consistent through the whole range of signal intensities. In this study, printing pin dependent normalization was also carried out regarding the printing pin as a representative multiplicative noise. It improved the distribution of spots in the Cy3-Cy5 scatter plot, but its effect was slight. These studies suggest that there are some influences of the signals on the local backgrounds and they must be considered for the normalization of cDNA microarray data.

A novel method using edge detection for signal extraction from cDNA microarray image analysis

Gene expression analyses by probes of hybridization from mRNA to cDNA targets arrayed on membranes or activated glass surfaces have revolutionized the way of profiling mega level gene expression. The main remaining problems however are sensitivity of detection, reproducibility and data processing. During processing of microarray images, especially irregularities of spot position and shape could generate significant errors: small regions of signal spots can be mis-included into background area and vice versa. Here we report a novel method to eliminate such obstacles by sensing their edges. Application of edge detection technology on separating spots from the background decreases the probability of the errors and gives more accurate information about the states of spots such as the pixel number, degree of fragmentation, width and height of spot, and circumference of spot. Such information can be used for the quality control of cDNA microarray experiments and filtering of low quality spots. We analyzed the cDNA microarray image that contains 10,368 genes using edge detection and compared the result with that of conventional method which draws circle around the spot.

Responsiveness of dendrites to the glutamate applied focally with pressure ejector and iontophoresis into hippocampal slices

Glutamate is the most common excitatory amino acid in the brain. Responsiveness of dendrites to the glutamate greatly varies depending on the application sites. Especially, a point of the maximal response to the glutamate of the dendrite is called as 'hot spot'. In our experiment, the responsiveness of the hot spot to the glutamate was investigated in the CA1 pyramidal neuron of the rat hippocampal slice. CNQX, the antagonist of AMPA receptor, blocked 95% of membrane current to the glutamate focal application (Igl). Train ejection of glutamate on one point of the dendrite increased or decreased the amplitude of Igl with the pattern of train, and the changes were maintained at least for 30 min. In some cases, glutamate train ejection also induced calcium dependent action potentials. To evoke long-term change of synaptic plasticity, we adopted theta-burst in the glutamate train ejection. The theta-burst decreased the amplitude of glutamate response by 60%. However, after theta-burst glutamate train ejection, the calcium dependent action potential appeared. These results indicated that the focal application of glutamate on the neuronal dendrite induced response similar to the synaptic transmission and the trains of glutamate ejection modulated the change of AMPA receptor.

Exercise-induced Acute Renal Failure in a Patient with Renal Hypouricemia / 대한신장학회잡지

We report a case of exercise-induced acute renal failure associated with renal hypouricemia in a 35- year-old man who complained of oliguria and back pain after swimming. Laboratory tests revealed that serum blood urea nitrogen and creatinine level were elevated, the serum uric acid concentration was subnormal(2.1 mg/dL). After conservative treatment, renal function was recovered. But, uric acid level decreased to 0.4 mg/dL. In addition, there was no supression of urate clearance to creatinine clearnace ratio(CUA/CCr) following the administration of pyrazinamide, and no increase of CUA/CCr after benzbromarone. Therefore, we think the cause of renal hypouricemia in this patient may be the subtotal defect in the urate transport.

Zn2+ modulates the responses of rat dorsal horn neuron to C-fiber stimulation and excitatory amino acids

Zinc contained in the neurons of central nervous system is activity-dependently released and then attenuates NMDA (N-methyl-D-aspartate)-induced neurotoxicity while augmenting non-NMDA-induced neurodegeneration. Zinc also has been reported to produce antinociceptive action on the inflammation- and nerve injury-induced hyperalgesia in the behavioral test. In this study, we investigated the effects of zinc on the responses of dorsal horn cells to NMDA, kainate and graded electrical stimulation of C-fibers. In the majority of WDR cells (70.6%), zinc current-dependently inhibited WDR cell responses to NMDA and in the remaining cells, produced biphasic responses; excitation followed by inhibition. Zinc augmented the responses of WDR cells to iontophoretical application of kainate. The dominant effect of Zn2+ on the responses of WDR cells to C-fiber stimulation was excitatory, but inhibition, excitation-inhibition and no change of the responses to C-fiber stimulation were induced. Ca2+-EDTA antagonized the excitatory or inhibitory effects of Zn2+ on the WDR cell responses. These experimental findings suggest that Zn2+ modulates the transmission of sensory information in the rat spinal cord.

Magnesium suppresses the responses of dorsal horn cell to noxious stimuli in the rat

Magnesium ion is known to selectively block the N-methyl-D-aspartate (NMDA)-induced responses and to have anticonvulsive action, neuroprotective effect and antinociceptive action in the behavioral test. In this study, we investigated the effect of Mg2+ on the responses of dorsal horn neurons to cutaneous thermal stimulation and graded electrical stimulation of afferent nerves as well as to excitatory amino acids and also elucidated whether the actions of Ca2+ and Mg2+ are additive or antagonistic. Mg2+ suppressed the thermal and C-fiber responses of wide dynamic range (WDR) cell without any effect on the A-fiber responses. When Mg2+ was directly applied onto the spinal cord, its inhibitory effect was dependent on the concentration of Mg2+ and duration of application. The NMDA- and kainate-induced responses of WDR cell were suppressed by Mg2+, the NMDA-induced responses being inhibited more strongly. Ca2+ also inhibited the NMDA-induced responses current-dependently. Both inhibitory actions of Mg2+ and Ca2+ were additive, while Mg2+ suppressed the EGTA-induced augmentation of WDR cell responses to NMDA and C-fiber stimulation. Magnesium had dual effects on the spontaneous activities of WDR cell. These experimental findings suggest that Mg2+ is implicated in the modulation of pain in the rat spinal cord by inhibiting the responses of WDR cell to noxious stimuli more strongly than innocuous stimuli.

A Case of Myelopathy due to Spinal Dural Arteriovenous Fistula Supplied by Branches of the Internal Iliac Arteries

Spinal dural arteriovenous fistulas are rare abnormal connections of artery and vein within the dura, at the level of the intervertebral foramen. A 57-year-old male developed weakness in both lower extremities and sphincteric dysfunction, which had stepwisely, progressive and fluctuating course since 6 months ago. He showed areflexia in both ankle & right knee. T-spine MRI showed high signal intensity with ill defined margin in T2WI and intensely enhanced by con-trast agent through lower thoracic and lumbosacral spinal cord. Selective spinal angiography revealed a dural arteriove-nous fistula with a nidus at thoracolumbar vertebral level, supplied by the internal iliac artery and enlarged medullary veins. Superselective angiographic embolization was done. Clinically, his symptoms has been ameliorated. We report a rare case of thoracic myelopathy due to spinal dural arteriovenous fistulas exclusively supplied by the branches of internal iliac artery.

Clinical study of interlocking intramedullary nailing on proximal or distal femur and distal tibia fracture / 대한정형외과학회잡지

No abstract available.

A Clinical and Mycological Study of Superficial Dermatophytoses / 대한피부과학회지

This study was made in order to investigate the present status of superficial dermatophytoses and some changes on the frequency of the diseases, sex distributions and varieties of the causative organisms. The survey was made by 1486 out-patients of dermatology clinic of National Medical Center from May to August in 1978. Following results are obtained: 1. The incidence of superficial fungal infections including Tinea versicolor is 22. 2% and Tinea versicolor alone is 2. 8% among total l486 out-patients. 2. The ratio of male to female patients is 190:140 and shows more prevalence in male. 3. The age group from 20 to 29 shows the highest incidence and 38. 3% of all patients with superficial fungal infection falls in this age group. 4. Tinea pedis reveals the commonest disease and others in decreasing frequency are Tinea corporis, Onychomycosis, Tinea manus, Tinea corporis, Candidiasis and Tinea capitis. 5. Coexisting fungal infection is found in 60 patients and is most prevalent in the age group from 40 to 49, related to the ratio of age specific coexisting cases to each age group patients. 6. Tinea pedis with Onychomycosis reveals the most prevalent coexisting superficial fungal infection and others in decreasing frequencies are Tinea pedis with Tinea manus, Tinea pedis with Tinea cruris, Tinea cruris witb Tinea corporis and so on. 7. Positive rate of KOH mount among 362 scrapings is 64. 7% and Tinea cruris shows the highest positive rate (86. O%.) and Tinea corporis the next (78. 6%). 8. 187 strains are isolated by Sabourauds dextrose agar, 140 from positive KOH scrapings and 47 from negative KOH scrapings. a. Trichophyton rubrum is the most common organism of superficial dermatophytosis (43 8%) b, Microsporum species reveal the most common organism of Tinea capitis (80%).