Occurrence of microplastics in municipal sewage treatment plants: a review

Municipal sewage treatment plants (STPs) are thought to be important point sources of microplastics in freshwater systems and many peer-reviewed articles have been published on this issue since mid-2010s. In this review, we summarize existing literature on the occurrence of microplastics in STPs and experimental methods used for isolation and identification of microplastics. The number concentrations of microplastics in STP influents were 15.1-640 L⁻¹, whereas those in the STP effluents were highly variable and ranged from not detectable to 65 L⁻¹. For most of cases, conventional STPs are removing microplastics very effectively. Fragments and fibers are dominant shapes of microplastics. Thermoplastics (polyethylene and polypropylene) and polyester are the predominant materials recovered. Although further research is needed, size distribution of microplastics in STPs is likely to follow a power law, implying that different studies using different size cutoffs may be compared after establishing a power law relationship.

Occurrence of microplastics in municipal sewage treatment plants: a review

Municipal sewage treatment plants (STPs) are thought to be important point sources of microplastics in freshwater systems and many peer-reviewed articles have been published on this issue since mid-2010s. In this review, we summarize existing literature on the occurrence of microplastics in STPs and experimental methods used for isolation and identification of microplastics. The number concentrations of microplastics in STP influents were 15.1-640 L⁻¹, whereas those in the STP effluents were highly variable and ranged from not detectable to 65 L⁻¹. For most of cases, conventional STPs are removing microplastics very effectively. Fragments and fibers are dominant shapes of microplastics. Thermoplastics (polyethylene and polypropylene) and polyester are the predominant materials recovered. Although further research is needed, size distribution of microplastics in STPs is likely to follow a power law, implying that different studies using different size cutoffs may be compared after establishing a power law relationship.

Preoperative Quality of Life in Patients with Gastric Cancer

PURPOSE: We evaluated the socio-personal and clinical factors that can affect preoperative quality of life to determine how to improve preoperative quality of life in patients with gastric cancer. MATERIALS AND METHODS: The preoperative quality of life data of 200 patients (68 females and 132 males; mean age 58.9+/-12.6 years) with gastric cancer were analyzed according to socio-personal and clinical factors. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 and the EORTC QLQ-STO22, a gastric cancer-specific module, were used to assess quality of life. Patients were asked to complete the questionnaire preoperatively by themselves. RESULTS: Patients with a higher academic background and stage I disease tended to have higher global health status scores. Highly educated younger men had better physical functioning scores. Highly educated and well-nourished patients with stage I cancer had higher role functioning scores. Married patients had better emotional scores. The symptom scales were affected by sex, age, education level, nutrition, and cancer stage. CONCLUSIONS: Preoperative quality of life in patients with gastric cancer can be improved by nutritional support and treatment of symptoms caused by disease progression. Psychological support may be helpful for patients with a poor quality of life.

Two Cases of Gastrocolocutaneous Fistula with a Long Asymptomatic Period after Percutaneous Endoscopic Gastrostomy

Gastrocolocutaneous fistula is a rare complication of the percutaneous endoscopic gastrostomy (PEG) procedure. Typical symptoms usually occur in the first few months. We recently encountered 2 patients with 8- and 33-month asymptomatic periods. A 74-year-old man presented with watery diarrhea for 1 month. He had undergone PEG 9 months earlier. During workup, an upper endoscopy and abdominal CT scan revealed the migration of the feeding tube into the transverse colon. He was discharged with a nasogastric tube after treatment. A 77-year-old man presented with sudden loosening of his PEG tube with a duration over 3 days. He had undergone PEG procedure three times until that time. During workup, a gastrocolocutaneous fistula was diagnosed. However, when previous studies were reviewed, an abdominal CT scan, which was done 6 months ago before the third PEG, showed the fistula already existed at that time, suggesting that it was created about 33 months earlier when he underwent the second PEG procedure. The patient died of pneumonia aggravation despite conservative treatment. Both a high index of suspicion and the careful inspection of the upper endoscopy are very important for early diagnosis regardless of symptoms.

A Case of Polymyositis with Normal Creatine Kinase / 대한내과학회지

Proximal muscle weakness can be induced by many diseases, such as muscular dystrophies, inflammatory muscle diseases, and polymyalgia rheumatica. Differential diagnosis of these diseases is important. The patient had proximal muscle weakness with a normal creatine kinase (CK) level. Our initial diagnosis was polymyalgia rheumatica because the CK level was normal. The patient was treated with low-dose corticosteroid. However, the muscle weakness did not improve. The diagnosis of polymyositis was confirmed by a muscle biopsy. We suggest that if the patient has typical symptoms with normal CK, then evaluations for inflammatory muscle diseases are essential.

Invasive Pulmonary Aspergillosis after Influenza A Infection in an Immunocompetent Patient / 결핵및호흡기질환

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient's symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

Changes of Quality of Life after Gastric Cancer Surgery

PURPOSE: The aim of this study was to evaluate chronological change of quality of life after surgery in patients with gastric cancer during one year postoperatively. MATERIALS AND METHODS: Quality of life data were obtained from 272 gastric cancer patients who underwent curative gastrectomy between September 2008 and February 2011 at the Kyungpook National University Hospital. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 with gastric cancer-specific module, the EORTC QLQ-STO22 were used to assess quality of life. All patients had no evidence of recurrence or metastasis during the first postoperative year. Patients were asked to complete the questionnaire, by themselves preoperatively, 3-, 6-, 9-, and 12-months postoperatively. RESULTS: Physical functioning score and role functioning score significantly decreased at first 3 months after surgery and the significant differences were noticed until 12 months after surgery. Emotional functioning score started with the lowest score before surgery and significant improvement was shown 6 months after surgery. Most symptom scores and STO-22 scores were highest at 3 months after surgery and gradually decreased, thereafter. Eating restriction, anxiety, taste, body image scores was highest at 3 months after surgery without significant decrease afterwards. CONCLUSIONS: Most scales worsened after surgery and gradually recovered afterwards with some differences in rate of recovery. However the scales did not fully recover by 1 year period. Further follow-up after 1 year would be helpful in determining which scales are permanently damaged and which are just taking longer time to recover.

A Case of Septic Pulmonary Embolism in an End-Stage Renal Failure Patient with Infected Arterio-venous Graft for Hemodialysis / 대한신장학회지

Septic pulmonary embolism (SPE) is different from non-infectious thromboembolism in that it causes pulmonary arterial obstruction and inflammation by infectious emboli from various sources. There are increased risks of SPE in patients with chronic kidney disease because of decreased immunity and frequent venous puncture with the use of indwelling venous catheters or arterio-venous graft (AVG). However, SPE related with AVG infection in end-stage renal failure patient is very rare. Recently, we experienced a typical case of septic pulmonary embolism occurring in a 57-year-old man with infected AVG during hemodialysis. The patient had started hemodialysis 10 years ago due to diabetic end stage renal failure. Due to functional failure of the arterio-venous fistula, hemodialysis had been performed through an AVG on the upper left arm 3 years before admission.

The Effect of Cobalt Chloride Pre-treatment on Experimental Ischemia-Reperfusion Renal Injury / 대한신장학회잡지

BACKGOUND: Cobalt chloride (COCL) has hypoxia-mimetic effects by inhibiting degradation of HIF-1alpha, which is a master regulator of genes activated by low oxygen tension. Heme oxygenase-1 (HO-1), an inducible heat shock protein, is known to have cytoprotective effects against ischemic injury. This study evaluated the efficacy of COCL in a bilateral renal ischemia-reperfusion (I-R) injury model of male Sprague-Dawley rats. METHODS: I-R renal injury was induced by 45 min clamping of both renal arteries. Rats in the sham (n=6) and I-R control groups (n=8) had been drinking tap water, whereas rats in the COCL treated sham (n=6) and COCL treated I-R groups (n=9) had been drinking water containing 2 mM COCL from day -10 to day 1. RESULTS: The serum level of creatinine 24 hrs after surgery was 2.6+/-1.1 (mean+/-SD) mg/dL in I-R COCL treated group, significantly lower than that in I-R control group (4.8+/-1.6 mg/dL, p<0.05). The renal HO-1 gene expression and protein signal were significantly upregulated in the COCL treated sham group compared to sham operated control rats (all, p<0.05). The expressions of TGF-beta MCP-1, TNF-alpha endothelin-1 and Fas genes in COCL treated I-R rats were significantly lower than those of I-R control rats (all, p<0.05). The level of Bcl-2 gene expression of COCL treated I-R rats was significantly higher than the level of I-R control rats (p<0.05). CONCLUSION: It is speculated that the pretreatment of COCL in I-R rat model attenuates ischemic renal injury and at least in part, upregulation of renal HO-1 is involved in this mechanism.

A case of systemic lupus erythematosus associated with Hashimoto's thyroiditis and aplastic anemia / 대한내과학회지

We report a 45-year-old female who presented with azotemia, pancytopenia, pericardial effusion, hypothyroidism, decreased complement and positive ANA and was diagnosed as systemic lupus erythematosus (SLE). She referred to our hospital for the evaluation of azotemia. Bone marrow findings were compatible with aplastic anemia and Hashimoto's thyroiditis was diagnosed. After 3 days of methylprednisolone pulse therapy, the aplastic anemia responded and started to improve. She is visiting our clinic on a regular interval and showing good response to maintenance therapy. Hashimoto's thyroiditis is not rare in SLE, and aplastic anemia is relatively rare in SLE but, SLE that is combined with Hashimoto's thyroiditis and aplastic anemia simultaneously, has not been reported as far as our knowledge concerned. So, we report a case of successful treatment of SLE combined with Hashimoto's thyroiditis and aplastic anemia by steroid and thyroxine.

Efficacy of erythropoietin in renal function of pre-dialysis patients with chronic renal failure / 대한내과학회지

BACKGROUND: Anemia is one of the most important risk factors for cardiovascular morbidity and mortality in patients with chronic renal failure. The most effective treatment modality for anemia is erythropoietin injection. Besides erythropoietic effect, erythropoietin has multiple beneficial effects such as anti-oxidant, anti-hypoxic, anti-apoptotic and vasculogenetic effects, and prevents tubular lesions and interstitial fibrosis. Despite lots of advantages of erythropoietin therapy, the number of patients treated with this agent is modest, particularly during the pre-dialysis chronic renal failure. We conducted a clinical trial to evaluate the effects of erythropoietin on renal function in the anemic pre-dialysis patients with chronic renal failure. METHODS: Data of 23 pre-dialysis patients with chronic renal failure were analyzed retrospectively 6 months prior, and prospectively 6 months after the initiation of erythropoietin therapy. Erythropoietin was admitted at a dose of 3000 IU weekly with supplementary iron. RESULTS: The average hematocrit and hemoglobin rose from 22.1+/-2.5%, 7.4+/-0.8 g/dL to 28.4+/-4.2%, 9.6+/-1.5 g/dL, respectively. When linear regression analysis was applied to pre- and post-erythropoietin glomerular filtration rate and 1/Cr, mean rate of decline of glomerular filtration rate were significantly delayed (p=0.039) but that of 1/Cr had a tendency to be delayed but was not statistically meaningful (p=0.099). CONCLUSIONS: Treatment of the anemia with low dose erythropoietin in pre-dialysis patients with chronic renal failure is relatively safe and may slow the rate of renal function deterioration.

Anaphylactic Reaction after an Intracervical Injection of Isosulfan Blue Dye: A case report / 대한마취과학회지

Isosulfan blue dye can be used to mark the sentinel lymph node during various surgeries. The dye was known to have minimal side effects, but recently a few cases of an anaphylactic reaction were reported in melanoma and breast surgery. We experienced an anaphylactic reaction during peritumoral injection of this dye in a patient with cervical cancer. Immediately after dye injection, the patient showed an anaphylactic reaction with cardiovascular collapse and oxygen desaturation. We resuscitated the patient and she recovered without complications.

Partial Endotracheal Tube Obstruction Due to Secretions: A case report / 대한마취과학회지

Endotracheal tube obstruction causes serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and brain death. A 64 year old man was scheduled for a laminectomy and instrument fixation due to spinal stenosis. The patient was intubated with a 8.5 mm reinforced endotracheal tube and turned to the prone position. An hour later, signs of partial endotracheal obstruction were observed including high airway pressure and low tidal volume. Airway obstruction signs were aggravated as the operation proceeded. Two hour later, passage of a suction catheter was difficult and PaCO2 increased significantly, so we temporarily stopped the operation and turned the patient to supine. After that, we exchanged the tube with another tube and found the distal tip of the reinforced tube impacted with mucous secretions.

The Effect of Intraperitoneal Hyperthermic Perfusion on the Postoperative Liver Function in Cancer Patient / 대한마취과학회지

BACKGROUND: Intraperitoneal hyperthermic perfusion (IPHP) has been introduced in clinical practice to improve the survival of cancer patients. But despite of this advantage, postoperative hepatic dysfunction may occur more severely after IPHP than general anesthesia. The protective mechanism of liver is destroyed by hyperthermia as the result. The purpose of this study is to evaluate the effect of intraperitoneal hyperthermic perfusion on the postoperative liver function in cancer patients. METHODS: Sixty patients with ovarian cancer were divided into two groups; 30 patients undergone only radical hysterectomy (control group), and 30 patients undergone radical hysterectomy combined with IPHP (IPHP group). Anesthesia was performed with enflurane-N2O-O2 in both groups. Serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and albumin levels were evaluated before anesthesia, 1, 3, 5, 7, 10 and 14th days after surgery on both groups. RESULTS: Postoperative SGOT levels were increased on 1, 3, 5, 7, 10 and 14th days in both groups, and on 1, 3 and 5 days postoperatively were increased more significantly in IPHP group than control group, but there were no significant difference between both groups after post-operative 7 days. SGPT levels were increased more significantly on 1, 3 and 5 days postoperatively in IPHP group than control group. Albumin levels were decreased more significantly on 1 and 3 days postoperatively in IPHP group than control group. CONCLUSION: We consider that postoperative liver function in cancer patients is influenced by the intraperitoneal hyperthermic perfusion.

Dosage Dependent Neurologic Impairment after Cerebral Air Embolism in Rabbit / 대한마취과학회지

BACKGROUND: A long-term objective is to understand the pathogenesis of neurologic injuries associated with cardiac surgery, cardiopulmonary bypass, and circulatory arrest. Our specific aims are to establish a dose of air which results in moderate to severe neurologic defects in normothermic (37degrees C) rabbits. METHODS: To first establish a dose of air which would cause unequivocal neurologic impairment, anesthetized rabbits received either 0, 50, 100 or 150 microgram l/kg of air into the internal carotid artery(n=5 in each group). One hour later, anesthesia was discontinued and animals were recovered. Animal were neurologically evaluated at 24 hours using a zero(normal) to 97(coma) point scale. RESULTS: There was a clear relationship between the dose of air injected and the severity of neurologic impairment at 24 hours, p=1.1x10(-7). Rabbits receiving 50 micrograml/kg of air were minimally affected and were difficult to distinguish from controls. In contrast, rabbits receiving 150 micrograml/kg of air were uniformly and unequivocally impaired. CONCLUSION: we recommend for future cerebral air embolism studies, 150 microgram l/kg as the optimal dose of air which would reliably produce viable subjects for 24 hours with marked unequivocal, neurologic impairment.