Post-cardiac injury syndrome (PCIS) is an uncommon complication arising from pericardial and myocardial damage, encompassing post-cardiac surgery, percutaneous intervention (PCI) for acute coronary syndrome, cardiac device implantation, and radiofrequency ablation. The etiology of PCIS is not clearly defined, with approximately 50% of cases remaining idiopathic.Manifestations and symptoms of PCIS vary significantly among patients. Herein, we report a rare case of a 62-year-old male with PCIS that occurred after PCI for non-ST elevation myocardial infarction in an end-stage renal disease (ESRD) hemodialysis (HD) patient. He suddenly developed chest pain, fever, low blood pressure, cold sweating, tachycardia, desaturation and cardiac tamponade with cardiogenic shock after one week of PCI. After emergency pericardiocentesis, he was able to come out of cardiogenic shock. Ultimately, his clinical symptoms improved further with concurrent long-term medical treatment such as non-steroidal anti-inflammatory drugs and colchicine. This case illustrates a rare and unusual case of a relatively subacute onset PCIS in an ESRD patient on HD following emergency PCI. Although pericardial effusion is commonly detected in ESRD patients on HD, cardiologist should not overlook PCIS in dialysis patients, given the potential resemblance to uremic pericarditis or effusion. In addition, imaging modality such as transthoracic echocardiography has significantly important roles in case of urgent situation in order to make differential diagnosis as like this case.

Background: This study aimed to identify the prevalence of workplace hazards and organizational protection resources according to the size of the enterprise in the manufacturing industry of the Republic of Korea. Methods: We analyzed data of waged workers (weighted N = 5,879) from the Fifth Korean Working Conditions Survey (2017). Enterprise sizes were categorized as “micro enterprises” (less than five employees), “small enterprises” (5–49 employees) and “medium-large enterprises” (50 or more employees). Self-reported exposure to 18 physical, chemical, ergonomic, and psychological hazards were measured. The presence of organizational protection resources such as a labor union, a safety delegate working at the company, designated spaces to deal with safety, and the provision of health and safety information was evaluated. Results: Compared to workers in medium-large enterprises, those in micro enterprises showed a higher proportion of exposure to most of physical, chemical, ergonomic, and psychological hazards, except for exposure to solvents, prolonged sitting, and experiencing a state of emotional unrest. On the other hand, workers in micro enterprises had the lowest proportion of access to organizational protection resources. Conclusion Our study demonstrates that manufacturing workers at the micro enterprise in the Republic of Korea are exposed to the most hazardous work environment and yet have access to the fewest organizational protection resources.

Background: Ammonia and hydrogen sulfide are harmful gases generated during aerobic/anaerobic bacterial decomposition of livestock manure. We evaluated ammonia and hydrogen sulfide concentrations generated from workplaces at livestock farms and determined environmental factors influencing the gas concentrations. Methods: Five commercial swine farms and five poultry farms were selected for monitoring. Real-time monitors were used to measure the ammonia and hydrogen sulfide concentrations and environmental conditions during the manure-handling processes. Monitoring was conducted in the manure storage facility and composting facility. Information on the farm conditions was also collected through interview and walk-through survey. Results: The ammonia concentrations were significantly higher at the swine composting facilities (9.5–43.2 ppm) than at other manure-handling facilities at the swine and poultry farms, and high concentrations of hydrogen sulfide were identified during the manure agitation and mixing process at the swine manure storage facilities (6.9–19.5 ppm). At the poultry manure-handling facilities, the ammonia concentration was higher during the manure-handling processes (2.6–57.9 ppm), and very low hydrogen sulfide concentrations (0–3.4 ppm) were detected. The air temperature and relative humidity, volume of the facility, duration of manure storage, and the number of animals influenced the gas concentrations. Conclusion A high level of hazardous gases was generated during manure handling, and some levels increased up to risk levels that can threaten workers' health and safety. Some of the farm operational factors were also found to influence the gas levels. By controlling and improving these factors, it would be possible to protect workers' safety and health from occupational risks.

PURPOSE: Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure. METHODS: The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group. RESULTS: Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively). CONCLUSION: Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes.
Adenocarcinoma ; Capecitabine ; Carcinoembryonic Antigen ; Chemoradiotherapy ; Humans ; Lung ; Lymph Nodes ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Rectal Neoplasms

BACKGROUND: IgA nephropathy (IgAN) is the most common form of glomerulonephritis, a principal cause of end-stage renal disease (ESRD) worldwide. The mechanisms of onset and progression of IgAN have not been fully revealed, and epidemiologic studies have yielded diverging opinions as to the role of occupational exposure to organic solvents in the initiation or worsening of IgAN. As the authors encountered a laboratory worker with IgAN that progressed to ESRD, we present a case report of IgAN progression due to dichloromethane exposure along with a review of literature. CASE PRESENTATION: A 41-year-old male laboratory worker began to experience gross painless hematuria after two years of occupational exposure to toluene. Although clinical follow-up was initiated under the impression of IgAN based on clinical findings, the patient continued to work for four more years in the same laboratory, during which he was in charge of laboratory analysis with direct exposure to a high concentration of dichloromethane without proper protective equipment. During that time, his renal function rapidly worsened and finally progressed to ESRD 10 years after the first clinical symptoms. The result of exposure assessment through reenactment of his work exceeded the occupational exposure limit for dichloromethane to a considerable degree. CONCLUSIONS: The causal association between occupational solvent exposure and IgAN is still unclear; therefore, this case report could be used as a basis to support the relevance of occupational solvent exposure to IgAN and/or its progression. Early intervention as well as close monitoring of laboratory workers exposed to various organic solvents is important to prevent or delay the progression of glomerulonephritis to ESRD in the occupational setting.
Adult ; Early Intervention (Education) ; Epidemiologic Studies ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Kidney Failure, Chronic* ; Male ; Methylene Chloride ; Occupational Exposure ; Solvents ; Toluene

Nonalcoholic steatohepatitis (NASH) is characterized by hepatocyte injury and inflammatory cell infiltration, which has been linked to peripheral insulin resistance and increased levels of triglycerides in the liver. The purposes of this study were to establish a mouse model of NASH by feeding mice a 60% high-fat diet (HFD) and to demonstrate the anti-fibrotic effects of oleuropein, which has been shown to have anti-oxidant and anti-inflammatory properties, in this HFD-induced mouse model of NASH. C57BL/6 mice were divided into three groups: a regular diet group (Chow), a HFD group and an oleuropein-supplemented HFD group (OSD), which was fed a 0.05% OSD for 6 months. The effects of oleuropein in this model were evaluated using biochemical, histological and molecular markers. The expression levels of alpha-smooth muscle actin (alpha-SMA)and collagen type I in the HFD and OSD groups were evaluated using real-time PCR and western blotting. The body weight, biochemical marker levels, nonalcoholic fatty liver disease activity score, homeostasis model of assessment-insulin resistance (HOMA-IR) and leptin levels observed in the HFD group at 9 and 12 months were higher than those observed in the Chow group. The HOMA-IR and leptin levels in the OSD group were decreased compared with the HFD group. In addition, alpha-SMA and collagen type I expression were decreased by oleuropein treatment. We established a NASH model induced by HFD and demonstrated that this model exhibits the histopathological features of NASH progressing to fibrosis. Our results suggest that oleuropein may be pharmacologically useful in preventing the progression of steatohepatitis and fibrosis and may be a promising agent for the treatment of NASH in humans.
Actins/genetics/metabolism ; Animals ; Antihypertensive Agents/*therapeutic use ; Collagen Type I/genetics/metabolism ; Diet, High-Fat/*adverse effects ; Fatty Liver/*drug therapy/etiology/metabolism ; Fibrosis/etiology/metabolism/prevention & control ; Iridoids/*therapeutic use ; Leptin/genetics/metabolism ; Liver/metabolism/pathology ; Mice ; Mice, Inbred C57BL

OBJECTIVE: This study evaluated the effects of temporary clipping on an infarction after middle cerebral artery aneurysmal surgery. METHODS: Three hundreds and seventeen patients with a middle cerebral artery aneurysm were treated surgically at our department. Among them, the patients who had an intracerebral hematoma or a cerebral infarction prior to surgery or poor clinical mental state (Hunt and Hess grade V) on admission were excluded from the analysis. Two hundreds and twenty nine patients were selected in this study. An acute cerebral infarction, which had no any evidence of retraction injury or vasospasm and occurred on the same side of the surgical site within 3 days after the operation, was regarded as the cerebral infarction as a result of the temporary clipping. RESULTS: Twenty out of 229 patients (8.7%) developed a new acute cerebral infarction after surgery. The causes of the infarction were as follows: 13 patients related to the temporary clipping, 5 patients to the vasospasm and 2 patients to the brain retraction injury. The incidence of an acute cerebral infarction according to the frequency of temporary clippings was 5.5% (3 of 55 patients) of those who underwent a single temporary clipping, 6.7% (4 of 60 patients) of those who underwent two or three temporary clipping and 20.7% (6 of 29 patients) of those who underwent more than 4 temporary clippings. The incidence of an acute cerebral infarction was significantly higher when the temporary clip had been applied more than 4 times (P<0.021). However, the clipping time didn't show statistically significance. CONCLUSION: The incidence of acute cerebral infarction after a surgery for a middle cerebral artery aneurysm was related to the frequency of temporary clippings during surgery. It was significantly higher in the cases where more than 4 temporary clipping had been applied.
Aneurysm ; Brain ; Cerebral Infarction* ; Hematoma ; Humans ; Incidence ; Infarction ; Intracranial Aneurysm* ; Middle Cerebral Artery*

Systemic multiple aneurysms are rare, and an association between intracranial and visceral arterial or abdominal aortic aneurysm in the same patient is a very rare occurrence. We report herein three such cases. In one case, aneurysms of the right internal carotid artery(ICA) and the right middle cerevral arterial bifurcation(MCAB) coexisted with the inferior pancreaticoduodenal arterial pseudoaneurysm and two ileal arterial aneurysms. In another case, the patient had the A-com arterial aneurysm and the right renal arterial aneurysm. And in the other patient, he had the right vertebral artery dissecting aneurysm with the abdominal aortic aneurym. Initially, all patients were referred to our hospital with subarachnoid hemorrhage(SAH), and thereafter first two patients developed visceral arterial aneurysm rupture in the course of hospital stay and in the last patient, the abdominal aortic aneurysm was detected incidentally during carotid angiogram for Guglielmi detachable coil(GDC) embolization of vertebral dissecting aneurym. After thorough review of our cases together with pertinent literatures, we emphasize the possibility of underlying extracranial aneurysms in ruptured intracranial arterial aneurysm patient and it's uncommon but fatal complication.
Aneurysm* ; Aneurysm, Dissecting ; Aneurysm, False ; Aortic Aneurysm, Abdominal ; Humans ; Length of Stay ; Rupture ; Vertebral Artery

This study was undertaken to examine effects of dietary intake of garcinia cambogia extract, soy peptide and L-carnitine mixture on body weight gain and obesity-related bio-markers in rats fed high-fat diet for 9 weeks with or without regular treadmill exercise. Forty 5-week-old male Sprague-Dawley rats were randomly divided into four groups; sedentary control group (SC), exercised control group (EC), sedentary formula-fed group (SF), and exercised formula-fed group (EF). The SC and EC rats were fed high-fat control diet (fat comprises 40% of total caloris), and SF and EF rats were fed high-fat formula (composed of garcinia cambogia, soy peptide and L-carnitine) supplemented diet. Statistical analyses by two-way ANOVA indicated that the regular treadmill exercise significantly lowered cumulative body weight gain, total visceral fat mass, and epididymal, perirenal and retroperitoneal fat pad weights, and serum concentrations of total cholesterol and LDL + VLDL cholesterol, insulin, c-peptide and leptin. Feeding the formula also resulted in significant reductions in cumulative body weight gain and visceral fat pad weights, along with other related parameters including serum total and LDL + VLDL cholesterol levels, and hepatic enzyme activities involved in fatty acid synthesis. Statistical analyses by one-way ANOVA revealed that the formula consumption significantly improved body weight gain (18% reduction), total visceral fat weight (20% reductions), and serum total (43% reduction) and LDL + VLDL cholesterol (54% reduction) levels, as well as serum levels of insulin (49% reduction), and c-peptide (41% reduction) in sedentary rats, but failed to exhibit significant reductions in these indices in animals under treadmill exercise program. Taken together, these results suggest that the treadmill exercise per se exhibited significant improvements in body fat reduction and other related bio-markers, and so the formula consumption did not achieve a further significant reductions in these bio-markers in exercised rats. Nevertheless, animals fed the formula with regular exercise showed the most efficient weight reduction compared to other groups either fed formula without exercise or received regular exercise without dietary supplementation.
Adipose Tissue ; Animals ; Body Weight* ; C-Peptide ; Carnitine* ; Cholesterol ; Cholesterol, VLDL ; Diet ; Diet, High-Fat* ; Dietary Supplements ; Garcinia cambogia* ; Garcinia* ; Humans ; Insulin ; Intra-Abdominal Fat ; Leptin ; Male ; Rats* ; Rats, Sprague-Dawley ; Weight Loss ; Weights and Measures

OBJECTIVE: To describe the clip reinforcement technique by circumferential wrapping with silastic sheet for the treatment of unclippable cerebral aneurysms and evaluate its long term follow-up results. METHODS: The nature of 26 unclippable aneurysms were as follow:12 blister-like superior wall aneurysm of internal carotid artery (ICA), 6 microaneurysms (<2 mm), 4 fusiform aneurysms, 4 broad-based aneurysms. After aneurysm and the parent artery are circumferentially wrapped by silastic sheet, aneurysm clips are positioned on the sheet with parallel to the parent artery. The mean follow-up period was 37 months (range, 3-140 months). RESULTS: 25 of 26 patients had a favorable outcome and one patient had a severe disabled due to severe vasospasm at 3 months after operation. Of the 21 patients who underwent immediate angiographic examination, stenosis of parent artery was detected in 6 patients and remnant of aneurysm in 4 patients. Asymptomatic occlusion of parent artery was observed in one patient on follow-up angiographic examination. 22 of 24 patients followed-up for a long time had a favorable outcome and 2 patients had a severe disabled (one patient was due to previous severe disabled and the other was due to thalamic intracerebral hematoma developed during the follow-up period). CONCLUSION: In our study, there was no clip reinforcement technique-related clinical complications such as rebleeding of aneurysm or ischemic event during follow-up period. Clip reinforcement technique by circumferential wrapping with silastic sheet is simple and useful method for the unclippable cerebral aneurysm.
Aneurysm ; Arteries ; Carotid Artery, Internal ; Constriction, Pathologic ; Follow-Up Studies* ; Hematoma ; Humans ; Intracranial Aneurysm* ; Parents