PURPOSE: The purpose of this study is to evaluate the effectiveness and the adverse events of high dose insulin/euglycemia therapy in acute calcium channel blocker (CCB) poisoning. METHODS: We developed a systematic search strategy and applied it to 4 electronic reference databases. We searched medical journals as well as the bibliographies of relevant articles. All forms of literature relevant to human use of high dose insulin for acute CCB poisoning were included. The literature search was conducted by two investigators in August, 2015 with publication language restricted to English and Korean. Case reports were divided between CCB overdose alone and multi-drug overdose including CCB. The effect and adverse event of high dose insulin and clinical outcome of each case were analyzed. RESULTS: Among 55 searched studies, 20 studies were included. A prospective study, a retrospective study, a systematic review study, and 17 case reports were identified. Case reports consisted of 11 CCB alone and 12 multidrug overdose cases including CCB. Although most cases described significant clinical improvements, one of them showed no beneficial effect. Several adverse events including hypoglycemia and hypokalemia were reported. No significant sequalae from adverse events was reported. CONCLUSION: Although there were many case reports demonstrating successful use of high dose insulin for CCB poisoning, the effect cannot be estimated due to a possibility of publication bias. Therefore, high dose insulin/euglycemia therapy might be considered adjunctive therapy in cases of CCB intoxication refractory for standard therapy.
Calcium Channel Blockers ; Calcium Channels* ; Calcium* ; Humans ; Hypoglycemia ; Hypokalemia ; Insulin ; Poisoning ; Prospective Studies ; Publication Bias ; Publications ; Research Personnel ; Retrospective Studies

PURPOSE: Despite advances in the techniques and development of new devices, endovascular (EV) procedures are not the panacea for peripheral vascular diseases. This is partly because substantial cases are too complicated to manage with only EV procedures and partly because of the relatively large size of devices. We reviewed our experience of hybrid vascular procedures and report here on their outcomes. METHODS: Between August 2008 and March 2010, thirteen cases of hybrid vascular operation were performed. A retrospective review of electronic medical records was performed. The primary outcome measures were technical outcomes and patency rates. RESULTS: The mean follow-up duration was 17.7 months. Treatment indications were as follows: critical ischemia (n=6), claudication (n=3), abdominal aortic aneurysm with leg ischemia (n=3), and unstable aortic atheroma with recurrent embolism (n=1). All operations were performed under local anesthesia in an angiography suite. A single surgeon and a single interventional radiologist performed all the major procedures together. Technical and clinical success rates were 92.3%. All limbs were salvaged in patients with critical ischemia. The primary patency rate of the 13 cases was 83.3% at 1 year. There was no in-hospital mortality. CONCLUSION: hybrid vascular operation is useful for patients with a complex vascular condition. The role of hybrid vascular operation should be established with regards to not only the cost benefit but also the long-term outcomes.
Anesthesia, Local ; Angiography ; Aortic Aneurysm, Abdominal ; Chimera ; Cost-Benefit Analysis ; Electronic Health Records ; Embolism ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Leg ; Outcome Assessment (Health Care) ; Peripheral Vascular Diseases ; Plaque, Atherosclerotic ; Retrospective Studies

Autosomal dominant polycystic kidney disease (ADPKD), one of the most common human monogenic diseases, is characterized by the presence of numerous fluid-filled renal cysts and is a leading cause of end-stage renal disease (ESRD). Urinary biomarkers may be useful for predicting the variable course of ADPKD progression from cyst growth to ESRD. Methods: To identify candidate urinary biomarkers of ADPKD progression, we used CRISPR/Cas9 genome editing to generate porcine fibroblasts with mono- and biallelic ADPKD gene knockout (PKD2+/– and PKD2–/–, respectively). We then performed RNA-sequencing analysis on these cells. Results: Levels of osteopontin (OPN), which is expressed by renal epithelial tubular cells and excreted into urine, were reduced in PKD2–/– cells but not in PKD2+/– cells. OPN levels were also reduced in the renal cyst cells of ADPKD patients. Next, we investigated whether OPN excretion was decreased in patients with ADPKD via enzyme-linked immunosorbent assay. OPN levels excreted into renal cyst cell culture media and urine from ADPKD patients were decreased. To investigate whether OPN can predict the rate of ADPKD progression, we compared urinary excretion of OPN in ADPKD patients with slow progression and those with rapid progression. Those with rapid progression had an estimated glomerular filtration rate of >60 mL/min/1.73 m2 . Urinary OPN excretion levels were lower in rapid progressors than in slow progressors. Conclusion: These findings suggest that OPN is a useful urinary biomarker for predicting ADPKD progression.