Right Heart Failure during Veno-Venous Extracorporeal Membrane Oxygenation for H1N1 Induced Acute Respiratory Distress Syndrome: Case Report and Literature Review

A 38-year-old male was admitted with symptoms of upper respiratory infection. Despite medical treatment, his symptoms of dyspnea and anxiety became aggravated, and bilateral lung infiltration was noted on radiological imaging studies. His hypoxemia failed to improve even after the application of endotracheal intubation with mechanical ventilator care, and we therefore decided to initiate venovenous extracorporeal membrane oxygenation (VV ECMO) for additional pulmonary support. On his twentieth day of hospitalization, hypotension and desaturation (arterial saturated oxygen <85%) developed, and right ventricular failure was confirmed by two-dimensional echocardiography. Therefore, we changed from VV ECMO to venoarteriovenous (VAV) ECMO, and the patient ultimately recovered. In this case, right ventricular dysfunction and volume overloading were induced by long-term VV ECMO therapy, and we successfully treated these conditions by changing to VAV ECMO.

Comparison of Extracorporeal Cardiopulmonary Resuscitation with Conventional Cardiopulmonary Resuscitation: Is Extracorporeal Cardiopulmonary Resuscitation Beneficial?

BACKGROUND: With improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR). METHODS: Between March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients' medical records. RESULTS: The return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis. CONCLUSION: The survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

Biological effects of fucoidan isolated from Fucus vesiculosus on thrombosis and vascular cells

BACKGROUND: Fucoidan is a highly sulfated glycosaminoglycan, which has a molecular structure similar to that of heparin. The antithrombotic effects of fucoidan in vitro have been widely reported, but its antithrombotic effects in vivo as well as its other biological properties in vitro have not been well investigated. METHODS: This study investigated the effects and mechanism of fucoidan from Fucus vesiculosus on thrombosis both in vitro and in vivo. A ferric chloride-induced mouse carotid artery thrombosis model was used to determine the antithrombotic effects of fucoidan in vivo. Additionally, changes in the levels of proinflammatory cytokines and chemokines were examined in vascular cells treated with fucoidan. RESULTS: In vivo studies employing a ferric chloride-induced mouse carotid artery thrombosis model indicated that fucoidan had a stronger antithrombotic activity than heparin. Further, vascular cells treated with fucoidan demonstrated a decrease in proinflammatory cytokine and chemokine production as well as inhibition of proliferation. CONCLUSION: The major findings of this study showed that fucoidan has a stronger antithrombotic effect than heparin in vivo and that fucoidan has an inhibitory effect on proinflammatory cytokine production and proliferation of vascular cells.

High Correlation between Alu Elements and the Conversion of 3' UTR of mRNAs Processed Pseudogenes

Even though it represents 6 13% of human genomic DNA, Alu sequences are rarely found in coding regions. When in exon region, over 80 % of them are found in 3' untranslated region (UTR). Pseudogenes are an important component of human genome. Their functions are not clearly known and the mechanism of how they are generated is still debatable. Both the Alu and Pseudogenes are important research problems in molecular biology. mRNA is thought to be a prime source of pseudogene and active research is going on its molecular mechanism. We report, for the first time, that mRNAs containing Alu repeats at 3' UTR has a significantly high correlation with processed pseudogenes, suggesting a possibility that Alu containing mRNAs have a high tendency to become processed pseudogenes. It is known that about 10% of all human genes have been transposed. Transposed genes at 3' UTR without Alu repeat have about two processed pseudogenes per gene on average while we found with statistical significance that a transposed gene with Alu had over three processed Pseudogenes on average. Therefore, we propose Alu repeats as a new and important factor in the generation of pseudogenes.

Expression of Vascular Endothelial Growth Factor in Cancer Tissues and Serum of Gastric Cancer Patients: Correlation with Clinicopathologic Findings and Prognosis

PURPOSE: Vascular endothelial growth factor (VEGF) is known to be produced by various malignant tumors and thought to be involved in microvascular permeability and angiogenesis. However, the clinicopathologic significance of the expression of VEGF in gastric cancer remains unclear. METHODS: To examine the relationship between VEGF expression in gastric cancer and clinicopathologic factors or patient survival, tumor VEGF expression was assessed by immunohistochemical study in 144 gastric cancer patients. In addition, serum VEGF (S-VEGF) level was measured by enzyme-linked immunosorbent assay in 116 patients and in 32 healthy controls. RESULTS: Positive staining for VEGF was observed in 68.8% (99 out of 144) of gastric cancers, and its expression was observed more frequently in patients with intestinal type and serosal invasion tumors. However, there was no significant correlation between the patients' survival and VEGF positivity. Significant differences in preoperative S-VEGF level were found between healthy controls and patients with gastric cancer (P=0.014), whereas there was no significant difference in the S-VEGF level between control and curative resection group. When S-VEGF levels were compared between groups categorized by different clinicopathologic vari-ables, a significant correlation was found between a high S-VEGF level and a tumor size greater than 5 cm, serosal invasion, lymph node and distant metastasis. Moreover, postoperative S-VEGF levels were significantly elevated as compared to preoperative levels (P=0.000). When the median S-VEGF level was used as a cutoff level, the survival rate of patients with elevated S-VEGF levels was significantly lower than that of patients with low levels (P=0.001). CONCLUSION: These results demonstrate that a high preoperative S-VEGF level is associated with tumor progression, metastasis and a poor outcome in patients with gastric cancer. Further studies are warranted to determine the clinical value of S-VEGF as an tumor marker and an indicator of tumor angiogenesis in gastric cancer.

Internal Urethrotomy Using Optical Urethrotome for Urethral Stricture / 대한비뇨기과학회지

Urethral stricture has been most complicated problem in the field of urology. We have experienced 17 times of endoscopic internal urethrotomy in 13 cases with urethral stricture and reviewed results and complications with a brief literatures. Of 13 cases, 9 cases have been followed for 3 to 20 months. Satisfactory results were obtained in 7 cases(77.8%). The complication rate was 11.8%(2 cases). Average duration of retaining catheter was 12 days. In conclusion, endoscopic internal urethrotomy is thought to be safe and first choice of procedure for urethral stricture.