BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

Proper positioning of pulmonary artery catheter and predicting distal migration of it during cardiopulmonary bypass is important for the prevention of perioperative complication of pulmonary artery rupture. The authors therefore examined the insertion length of pulmonary artery catheter via right internal jugular vein at which catheter tip was advanced to the most proximal position where pulmonary capillary wedge pressure could be obtained. And also the distal migration is measured by comparing the difference between prebypass and postbypass corrected length. Just before bypass, pulmonary artery catheter was arbitrarily receded 5cm for the prevention of spontaneous distal migration and wedging. The subjects were 47 patients who underwent open heart surgery (valve replacement, coronary artery bypass graft) during the period of November, 1992 through April, 1993. The results were as follows. 1) The insertion length of pulmonary artery catheter from skin to the right ventricle inlet, pulmonary artery inlet and pulmonary capillary wedge position were 26.5+/-3.0 cm, 36.8+/-4.9 cm and 46.1+/-5.7 cm respectively. 2) There were no significant statistical correlations between insertion lengths and patient constitutions such as body weight and height(r=0.144, r=0.032). 3) Locations of catheter tips were distributed to the 0.9+/-3.1 cm left to the spinous process, 1.9+/-1.6 cm inferior to the carina ; mostly LLQ of the lung field(51%). 4) During cardiopulmonary bypass, pulmonary artery catheter tips were migrated distally in 93.6% of the cases and the migration lengths were 2.7+/-2.0 cm. 5) There were no major perioperative complications caused by pulmonary artery catheterization. These results suggest that 5 cm withdrawal of pulmonary axtery catheter just before cardiopulmonary bypass can prevent the fatal complication of pulmonary artery rupture owing to its spontaneous distal migration.
Bays ; Body Weight ; Capillaries ; Cardiopulmonary Bypass ; Catheterization, Swan-Ganz ; Catheters* ; Constitution and Bylaws ; Coronary Artery Bypass ; Extracorporeal Circulation* ; Heart Ventricles ; Humans ; Jugular Veins ; Lung ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Rupture ; Skin ; Thoracic Surgery

BACKGROUND: Both atrophic gastritis and intestinal metaplasia may progress to gastric dysplasia. This study aimed to analyze the factors influencing progression of atrophic gastritis and intestinal metaplasia to dysplasia. METHODS: People diagnosed with atrophic gastritis and intestinal metaplasia for the first time received a follow-up endoscopy and were investigated for the cumulative incidence rate of gastric dysplasia by age, gender, smoking habit, alcohol intake, rice consumption and family history of stomach cancer. RESULTS: The cumulative incidence rate increased with age, consuming > or =3 bowls of rice per day and family history of stomach cancer. Multivariate analysis showed that the cumulative incidence rate of gastric dysplasia increased in subjects >61 years (RR=2.54, P=0.014), in those consuming > or =3 bowls of rice per day (RR=1.46, P=0.021) and in those with a family history of stomach cancer (RR=1.31, P=0.037). CONCLUSIONS: More active management, such as intensive endoscopic follow-up examinations, lifestyle change and education regarding gastric dysplasia, are required in those older than 61 years, having a higher intake of grain or with a family history of stomach cancer.
Edible Grain ; Endoscopy ; Follow-Up Studies ; Gastritis, Atrophic ; Humans ; Incidence ; Life Style ; Metaplasia ; Multivariate Analysis ; Risk Factors ; Smoke ; Smoking ; Stomach ; Stomach Neoplasms

Methods: The mixture of IB and DJ extracts was analyzed for its total flavonoid content (TFC), total polyphenol content (TPC), and radical scavenging activities. Gastric lesions were induced by treating rats with 1 mL of a solution containing 60% ethanol and 150 mM HCl.The rats were then divided into 5 groups: CON (normal control), HEC (treated with 150 mM HCl-60% ethanol and distilled water), IBE (treated with 150 mM HCl-60% ethanol and IB extract at 350 mg/kg body weight [BW]), ID30 (treated with 150 mM HCl-60% ethanol and a mixture of IB and DJ extracts in a 7:3 ratio at 350 mg/kg BW), and DJE (treated with 150 mM HCl-60% ethanol and DJ extract at 350 mg/kg BW). Results: The ID30 group exhibited significantly higher TFC, TPC, and radical scavenging activities than the groups treated with single extracts. This group also showed a notable decrease in the formation of gastric lesions and preservation of gastric wall mucus. In addition, the serum levels of the inflammatory marker tumor necrosis factor (TNF)-α were significantly lower in the ID30 group than in the HEC group. Conclusion The antioxidants present in the ID30 mixture effectively reduced oxidative stress and reactive oxygen species, mitigating gastric mucosal irritation induced by alcohol and acid. Furthermore, the mixture inhibited gastric acid secretion and inflammatory marker expression, such as TNF-α, preventing tissue damage. These findings suggest that the ID30 mixture is a potential preventative treatment for gastritis.

Photic retinal injuries following operating microscopic light exposure or endoillumination are produced by mechanical, thermal or photochemical mechanism. The authors experienced a case of a patient who developed a round macular lesion which seemed to be a light-induced retinal damage during pars plana vitrectomy and removal of intraretinal foreign body.
Foreign Bodies ; Humans ; Retinaldehyde* ; Vitrectomy*

3-Deazaadenosine (DZA), one of the potent inhibitors of S-adenosylhomocysteine hydrolase, is known to possess several biological properties including an induction of apoptosis. To evaluate a possibility that DZA may be utilized for the treatment of human leukemia, we studied molecular events of cell death induced by DZA in human leukemia HL-60 and U-937 cells. DZA induced a specific cleavage of poly ADP-ribose polymerase (PARP) and an activation of the cysteine protease caspase-3/CPP32 which is known to cleave PARP. DZA-mediated nuclear DNA-fragmentation was completely blocked in the presence of a universal inhibitor of caspases (z-VAD-fmk) or the specific inhibitor of caspase-3 (z-DEVD-fmk) unlike of cycloheximide (CHX). DNA fragmentation was preceded by the lowering of c-myc mRNA in the DZA treated cells. In addition, DZA-induced apoptosis was blocked by pretreatment with adenosine transporter inhibitors such as nitrobenzylthioinosine (NBTI) and dipyridamole (DPD). Taken together, these results demonstrate that DZA-induced apoptosis initiated through an active transport of DZA into human leukemia cells, is dependent on the caspase-3-like activity without de novo synthesis of proteins and possibly involves c-myc down-regulation.
Adenosine/metabolism ; *Apoptosis ; Biological Transport, Active ; Carrier Proteins/metabolism ; Caspases/*metabolism ; Down-Regulation ; Enzyme Activation ; Genes, myc ; HL-60 Cells ; Human ; Leukemia, Promyelocytic, Acute/*drug therapy ; Thioinosine/*analogs & derivatives/pharmacology ; Transcription Factors/genetics ; Tubercidin/*pharmacology ; U937 Cells

BACKGROUND: Mild cognitive impairment (MCI) represents a transitional state between the cognitive changes of normal aging and very early dementia. Recently, the published MCI classification in `The Current Concepts in MCI Conference' suggested subtypes of MCI (amnestic, single nonmemory domain, multiple domains slightly impared) based on recognized heterogeneity. The purpose of this study was to ascertain the existence of subtypes of MCI and investigate their relative prevalence and clinical characteristics. METHODS: We recruited the MCI patients according to the consensus criteria of MCI. We classified them into 3 subtypes of MCI by our working criteria based on the definitions of MCI subtypes and then calculated their respective prevalence. We described their various clinical variables including demographic features, symptoms on the first visit, neuroimaging findings, and the genotype of apolipoprotein E. RESULTS: Sixty patients (36 females and 24 males) were enrolled as MCI and analyzed. The prevalence of each subtype (amnestic, single nonmemory domain, multiple domains slightly impared) were 13 (21.67%), 24 (40.0%), and 23 (38.33%) respectively, suggesting the most prevalent type was the single nonmemory domain type. MCI cases with subcortical vascular features were 18 (11 single nonmemory domain and 7 multiple domains slightly impaired). The ApoE epsilon4 carriers were about 50% of tested patients. CONCLUSIONS: We ascertained the existence of MCI subtypes and investigated their prevalence and various clinical features. In evaluation of MCI patients, we should keep the notion of heterogeneity and subclassification in mind.
Aging ; Apolipoproteins ; Apolipoproteins E ; Classification ; Consensus ; Dementia ; Female ; Genotype ; Humans ; Mild Cognitive Impairment* ; Neuroimaging ; Population Characteristics ; Prevalence

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. METHODS: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. RESULTS: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. CONCLUSIONS: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.
Acute Kidney Injury ; Aged* ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Medical Records ; Patients' Rooms ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Shock, Septic ; Ventilator-Induced Lung Injury

ESWL is an effective treatment for renal and ureteral calculi with few serious side effects. Most complications are related to an obstruction from stone fragments lodged within the ureter with an accompanying colic and/or infection and subcapsular or perirenal hematoma. Here we report a patient with a protein S deficiency sustaining a deep vein thrombosis following an ESWL for a mid ureter stone.
Colic ; Hematoma ; Humans ; Protein S Deficiency* ; Protein S* ; Thrombosis ; Ureter ; Ureteral Calculi ; Veins ; Venous Thrombosis*

ESWL is an effective treatment for renal and ureteral calculi with few serious side effects. Most complications are related to an obstruction from stone fragments lodged within the ureter with an accompanying colic and/or infection and subcapsular or perirenal hematoma. Here we report a patient with a protein S deficiency sustaining a deep vein thrombosis following an ESWL for a mid ureter stone.
Colic ; Hematoma ; Humans ; Protein S Deficiency* ; Protein S* ; Thrombosis ; Ureter ; Ureteral Calculi ; Veins ; Venous Thrombosis*