Three distinct atmospheric circulation patterns associated with high temperature extremes in South Korea.

The negative impact of extreme high-temperature days (EHDs) on people's livelihood has increased over the past decades. Therefore, an improved understanding of the fundamental mechanisms of EHDs is imperative to mitigate this impact. Herein, we classify the large-scale atmospheric circulation patterns associated with EHDs that occurred in South Korea from 1982 to 2018 using a self-organizing map (SOM) and investigate the dynamic mechanism for each cluster pattern through composite analysis. A common feature of all SOM clusters is the positive geopotential height (GPH) anomaly over the Korean Peninsula, which provides favorable conditions for EHDs through adiabatic warming caused by anomalous downward motion. Results show that Cluster 1 (C1) is related to the eastward-propagating wave train in the mid-latitude Northern Hemisphere, while Cluster 2 (C2) and 3 (C3) are influenced by a northward-propagating wave train forced by enhanced convection in the subtropical western North Pacific (WNP). Compared to C2, C3 exhibits strong and eastward-extended enhanced convection over the subtropical WNP, which generates an anomalous high-pressure system over the southern part of the Kamchatka Peninsula, reinforcing EHDs via atmospheric blocking. Our results can contribute to the understanding of East Asia climate variability because wave trains influence the climate dynamics of this region.

Nafamostat mesilate for anticoagulation in continuous renal replacement therapy.

PURPOSE: During continuous renal replacement therapy (CRRT), anticoagulation of the extracorporeal circuit is required. The aim of this study was to assess the efficacy and safety of nafamostat mesilate, a serine protease inhibitor, compared with heparin.
 METHODS: We retrospectively studied 222 patients treated with CRRT in the intensive care unit (ICU). Clinical and filter-related data were extracted.
 RESULTS: We reviewed the medical records of the patients treated with CRRT. Initial anticoagulation methods were 56 heparin and 25 nafamostat mesilate; 10 patients received infused heparin systemically, and 131 patients were treated without anticoagulation. Total number of filters used was 1,236. Median filter lifespan with nafamostat mesilate was significantly greater than heparin (24.3 vs. 17.5 hours, p<0.001) and Kaplan-Meier survival plots revealed the longer survival of the circuits using nafamostat mesilate than heparin or without anticoagulation. In Cox proportional hazard models, nafamostat mesilate predicted longer filter survival. Although nafamostat mesilate induced activated partial thromboplastin time prolongation in 11 circuits (5.4%), bleeding episodes were not increased. 
 CONCLUSIONS: Nafamostat mesilate anticoagulation was associated with prolonged filter survival compared with heparin. These data suggest that nafamostat mesilate is a good choice for anticoagulant with prolonged filter survival during CRRT in critically ill patients.

Retroperitoneal hemorrhage after endoscopic removal of a fish bone stuck in the duodenum of a patient receiving hemodialysis.

Fish bones are often ingested accidently. Most of them passes out through the gastrointestinal tract safely, but serious complications, such as perforation, abscess, obstruction, and bleeding in the gastrointestinal tract, can occur. An ingested fish bone can be easily removed by endoscopy, and surgery is rarely required. However, there may be complications related to the endoscopic procedure including mucosal laceration, bleeding, fever, and perforation. Here, we report a case of retroperitoneal hemorrhage developed after endoscopic removal of a fish bone stuck in the duodenal wall, and then resolved spontaneously by conservative care.

High-sensitivity C-reactive protein can predict major adverse cardiovascular events in Korean patients with type 2 diabetes.

Inflammation is thought to play a role in the pathogenesis of major adverse cardiovascular events (MACE). It has been suggested that the measurement of markers of inflammation may aid in predicting the risk of such events. Here, the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and MACE in Korean patients with type 2 diabetes is assessed. A retrospective cohort study was conducted as a follow-up among 1,558 patients with type 2 diabetes and without cardiovascular diseases over a mean period of 55.5 months. A Cox proportional-hazards model was used to determine whether increased hs-CRP levels are useful as a predictor for future MACE. The hazard ratio of MACE was 1.77 (95% CI; 1.16-2.71) in subjects who had the highest hs-CRP levels (> 0.21 mg/dL) compared to subjects who had the lowest hs-CRP levels (< 0.08 mg/dL), after adjusting for age, regular physical activity, current smoking, and duration of diabetes. The present results indicate that high hs-CRP levels can act as a predictor for the MACE occurrence in Korean patients with type 2 diabetes.

Unusual Presentation Chronic Pulmonary Embolism due to Calcified Right Ventricular Mass.

Cardiac calcified amorphous tumors (CATs) can arise in all four chambers of the heart. Cardiac CATs can cause diverse symptoms according to their locations, and mass or embolic effects. Pulmonary emboli arising from cardiac CATs have been reported, but the true incidence is unknown due to their rarity. Herein we report a rare case with diffuse CATs in the right ventricle which caused a calcific pulmonary embolism and right-sided heart failure. Echocardiography, chest non-contrast computed tomography, and cardiac magnetic resonance imaging helped us diagnose the CATs. We recommend the usefulness of a multimodality imaging approach to characterize intracardiac masses and their complications accurately.