, Seoyoung Kim, Dohyoung Rim 
, Zhong Yuan, Hu Yao Blood and urine are commonly used specimens for clinical testing, and their contents, particularly exosomal microRNA (miRNA), are diverse, reflecting the metabolic activities of tissues and organs in the body.
Blood and urine samples were collected from six healthy adults. Exosomes were then enriched from these samples, followed by sequencing and bioinformatic analysis of exosomal miRNA.
The comparative analysis of miRNAs in blood and urine revealed that 41 miRNAs were more abundant in blood, while 61 were found at lower levels. Notably, hsa-miR-934 was among those with higher expression in blood, whereas hsa-miR-425-5p was one of the miRNAs with lower expression. Kyoto Encyclopedia of Genes and Genomes pathway analysis indicated that the target mRNAs of differentially expressed exosomal miRNAs (DEexo-miRNAs) in both blood and urine are implicated in various signaling pathways, including proteoglycans in cancer, axonal guidance, and the regulation of the actin cytoskeleton. Additionally, the target mRNAs associated with DEexo-miRNAs in urine were also linked to processes such as ubiquitin-mediated proteolysis and the phosphatidylinositol signaling system. In contrast, the target mRNAs corresponding to DEexo-miRNAs in blood were involved in the FoxO signaling pathway and chronic myeloid leukemia, among others.
This study observed differential expression of exosomal miRNAs in blood and urine, thereby enriching the available library of exosomal miRNA for these two sample types. It also lays the groundwork for the detection of exosomal biomarkers from blood and urine.
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, Jisoo Park, Yeonjoo Choi, Sanghoon Shin, Junbeom Park This study investigated the 24-hour ambulatory blood pressure monitoring (ABPM) and Holter parameters for evaluating their prognostic significance of cardiovascular events including stroke in population without atrial fibrillation (AF).
Among 3,199 patients that underwent ABPM, 335 who also underwent Holter recordings were selected in a tertiary hospital. Seventeen patients who had been documented with AF on Holter monitoring or diagnosed with AF were excluded, and finally 318 patients were analyzed. The association between cardiovascular events and ABPM/Holter parameters was analyzed by a logistic regression model, and the risk factors were estimated by a Cox hazard model. Age, sex, and histories of cardiovascular disease were adjusted by a multivariable analysis, and the cut-off values were suggested by a Kaplan-Meyer analysis.
During the total follow-up (28.5±1.7 months), 13 (4.1%) stroke, 6 (1.9%) heart failure, and 12 (3.8%) acute coronary syndrome incidences were observed. In the univariate analysis of the ABPM parameters, an increment in the night systolic BP (hazard ratio=1.034, P=0.020) and night diastolic BP (hazard ratio=1.063, P=0.031) significantly elevated the risk of a stroke occurrence. According to the Kaplan-Meyer analysis, there was a significant difference in the stroke incidence between the groups divided by a cut-off value of the night systolic BP of 120 mmHg (P=0.014) and night diastolic BP of 75 mmHg (P=0.023).
In a population without AF, the nocturnal BP was a significant predictor of a stroke incidence. At this point, the cut-off value of mean 120/75 mmHg in 24 ABPM was advisable.
Type 1 diabetes requires lifelong insulin therapy because insulin-secretion capability is diminished. Glycemic control and glucose monitoring are important to prevent type 1 diabetes complications. Diabetes technologies have developed rapidly; continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are now common and greatly aid glycemic control, especially in children and adolescents. The National Health Insurance Service has provided partial reimbursements for both CGM and CSII devices since 2019 and 2020, respectively; the devices are thus expected to become more popular. CGM reduces the frequency of hypoglycemia and the level of glycated hemoglobin. CSII affords more precise glycemic control than multi-dose insulin therapy. CSII showed reduced frequency of hypoglycemia and improved metabolic outcome without an increase in the body mass index z-score. Technological advancement of combined CGM and CSII will eventually serve as an artificial pancreas. The National Health Insurance Service should fund not only the devices but also education of patients and caregivers. In addition, healthcare providers must be continuously updated on new diabetes technologies.
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, Jung Eun Choi, Hae Soon Kim, Kyung Ha Ryu Diamond-Blackfan anemia (DBA) is a rare, inherited bone marrow failure syndrome that manifests as anemia in early infancy. Blood transfusion is a critical factor for survival. However, blood transfusions can result in iron overload. Endocrinopathies, hepatic cirrhosis, and cardiomyopathy are the most common complications of iron overload. Here, we report the case of an 18-year-old boy with DBA with hyperglycemia, short stature, and absence of puberty. The patient showed endocrine dysfunction associated with iron overload caused by repeated transfusions. He was eventually diagnosed with acquired hypopituitarism and was placed on testosterone replacement therapy. Endocrine dysfunction is common in patient with DBA, with an early manifestation of symptoms, even in teenage years. Patients receiving corticosteroid treatment or those in remission may also exhibit endocrine dysfunction, although its prevalence is the highest among chronic transfusion patients. Ongoing monitoring and evaluation of growth and pubertal development are needed for better management of these disorders.
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, Dong Been Park Animal models of peripheral nerve ischemia have yielded variable results.
The question of whether postischemia re-estableshment of blood flow to the nerves auguments injury has not been examined.
To study this question, the ipsilateral common iliac and femoral arteries were occluded with arterial snares for 3 hours in rats. C14-butanol tissue distribution was then used to measure blood flow in both sciatic and posterior tivial nerve trunks during occlusion and reperfusion.
Clinical limb function was graded serially, with the undisturbed contralateral limb serving as the study control. Nerve blood flow was reduced throughout the ischemic period and was only 20% of the control value in the posterior tibial nerve. All rats had functional impairment with an average limb function score of 7.5(normal score<2). During reperfusion period, blood flow in the distal sciatic and posterior tibial nerves was approximately double that of control nerbes at 2 hours.
At 21 hours, tibial nerve blood flow was still twice that of the control nerve, but flows in the distal sciatic nerve were unchanged from control levels. Clinically, limb function improved progressively after reperfusion.
It was concluded that nerve ischemia is attended by a relatively prolonged hyperemic flow response during reperfusion.
, Honkeun Cho, Si-Hoon Park, Gil Ja Shin, Dong Su Lee, Yang Hee Lim The Measurement of blood pressure by a doctor may trigger a pressor response, so there are marked differences between office and ambulatory or self-measured blood pressure and the subjects may misdiagnosed as hypertensives and receive unneccesary medication. The study is designed to evaluate the charicteristic of white coat hypertension, the degree of white coat effect and the relationship between the white coat hypertension and persistent hypertension.
Thirteen patients with office hypertension receiving no medication, were recruited from 434 patients experienced in ambulatory blood pressure. Past history, physical examination, office blood pressure, 12-channel standard electrocardiography, chest X-ray, plasma lipid battery, echocardiography and 24-hr ambulatory blood pressure monitoring with BP3 MEDIANA were performed.
1) White coat hypertensive patients were 13 of 434 patients(2.99%) who were performed 24-hr ambulatory blood pressure monitoring. The mean age was 45±12 years with 6 men and 7 women and rage of age was 26-65 years.
2) The lipid battery, chest X-ray and 12-channel standard electrocardiographty showed no significant finding.
3) The LV mass index was 90.7±11.0g/m3 but one of 8 who performed echocardiography showed concentric hypertrophty.
4) The LV ejection traction was 60.8±8.7% which normal range.
5) The mitral flow velocity parameters were E velocity 0.71±0.14m/sec, A velocity 0.54±0.24m/sec, E/A ratio 1.6±0.8, mitral valve deceleration time 214±27.6msec and isovolumic relaxation time 104±11.4msec but one of 8 showed LV relaxation abnormality.
6) The mean office systolic blood pressure was 159±13.8mmHg, mean office diastolic blood pressure 101±9.0mmHg, 24-hr mean ambulatory systolic blood pressure 128±4.9mmHg and 24-hr diastolic bliid pressure 82±8.6mmHg.
7) The night day ratio of systolic blood pressure was 0.93±0.06 and the night day ratio of diastolic blood pressure was 0.92±0.06 suggestive of blunted diurnal variation. The Dipper were 5 of 13 patients(38.5%) and the non-Dipper were 8 of 13 patients(61.5%).
8) Two of 13 white coat hypertensives were diagnosed as persistent hypertensives in follow-up periods and antihypertensive drug had been initiated.
White coat hypertension can be diagnosed by 24-hr ambulatory blood pressure monitoring. The influence of white coat effect to cardiovascular system was not established. Sixty-two percent of white coat hypertensives showed blunted diurnal variation in 24-hr ambulatory blood pressure monitoring and two of 13 were diagnosed as persistent hypertensives in our F/U study, so white coat effect cannot be merely innocent and need strict evaluation and regular follow-up.
, Jong In Han, Rack Kyung Chung, Gui Yong Lee, Jong Hak Kim, Chi Hyo Kim, Choon Hi Lee The head-down tilt(HDT) position infuses changes in cerebral blood flow, intracranial pressure, hemodynamic and respiratory system. This study was performed to evaluate the changes in cerebral blood flow and the onset of autoregulation according to the different degree of HDT.
The subjects were 12 healthy adult female volunteers. They were divided two groups : 10° HDT(group 1) and 15° HDT(group 2). The systolic, diastolic and mean blood pressure, heart rate, end-tidal CO2 concentration and cerebral blood flow velocity on middle cerebral artery by transcranial Doppler were measured before positioning and 1,2,3,5,7,9,11 minute after positioning.
There was no significant changes in cerebral blood flow velocities statistically according to the HDT under 15 degrees. In group 1, vean arterial blood pressure were increased at 5 minutes and returned to control value at 7 minutes after HDT with statistical significances. Diastolic blood pressure in group 1 were increased at 1 and 2 minutes after HDT with statistical significances. In froup 2, systolic blood pressure were increased at 5,7,9,11 minutes after HDT statistically significantly.
There were no significant changes of cerebral blood flow under less than 15° HDT. But systolic blood pressure were increased with 15° HDT in the healthy adults statistically significantly(p<0.05) not but clinically. So, we suggested that if HDT is required, we should take care of the partients more than 10 minutes after HDT.
Elevated serum lgE and pheripheral blood eosinophilia are immunologic hallmark in helminthic infections. Recently, these responses are known to be regulated by Th2-specific cytokine IL-4 and IL-5, respectively. And also, the antagonistic effects of IFN-γ on Th2 cell proliferation were shown
5-6week old male BALB/c mice treated with IFN-γ were divided into 3 groups. All the mice were inoculated orally with 20 metacercariae of
The serum lgE levels in groupIand II were decreased compared with those of infected mice with no treatment with rIFN-γ, but not significantly. The number of pheripheral blood eosinophils in group I and II were decreased compared with those of infected mice with no treatment with rIFN-γ, especially significant(
These results suggest that IFN-γ decreases Th2 cytokine response in
, Duk-Hee Kang Kidney transplantation is the best treatment for end-stage renal disease patients. However, the relative shortage of organs for transplantation has led to ABO-incompatible kidney transplantation as an accepted method to expand the pool of kidney donors. Recent advances in immunosuppression and antibody removal methods have made ABO-incompatible kidney transplantation more feasible, and have increased the opportunities for patients to receive kidney transplantation, as well as for special patients with ABO-compatible donor. Indeed, the outcome of ABO-incompatible kidney transplantation has shown remarkable developments and is now comparable to that of ABO-compatible kidney transplantation during last decade. However, there are still some uncertain issues to be addressed in ABO-incompatible kidney transplantation. In this article, we reviewed the current status and protocol of ABO-incompatible kidney transplantation and listed the concerns to be addressed in near future.
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, Jae Jin Han There have been many parameters that determined the results of radiocephalic ffisutla. However, few reliable intraoperative parameters have been suggested until now. The purpose of this study was to find the correlation between intra-operative blood flow and early patency of radiocephalic fistula.
Between March 1998 and October 1999, 45 radiocephalic arteriovenous fistulas were constructed in 38 patients. Intra-operative blood flow measurements were made 10 minutes after complection of the vascular anastomoses with 3-4mm handheld flow probes. Patients were followed until failure of fistula or 3months after first hemodialysis with these fistulas. Intraoperative blood flow as well as age, sex, presence of diabetes, size of cephalic vein, thrill on the fistula and flow of radial artery were correlated with early patency.
The mean intraoperative blood flow was 195.9±16.7 mL/min ranged from 50 to 500 mL/min, and it was the only significant parameter that determined early patency of radiocephalic fistula. Fistulas with flow less than 150 ml/min(10 of 18) revealed higher failure rate than those of flow more than 150 ml/min(1 of 27), which was statistically significant(p<0.01). All of the patients with flow less than 70 ml/min(5 of 5) failed in maintaining patency within a month. However, the other variables were not correlated with early patency.
In conclusion intra-operative blood flow measurements can be performed with ease and intraoperative blood flow in radiocephalic fistula is well correlated with early patency of the fistula. And we rocommend that radio-cephalic fistula of flow less than 150mL/min should be observed carefully and that of flow less than 70mL/min must be abandoned intraoperatively.
, Kyung Hee Kim To access the changes of cerebral blood flow velocity according to the time after surfactant administration, we prospectively studied in the Hyaline Membrane Disease using Doppler ultrasonography.
The patients were 26 infants. The mean gestational age was 3l4wks (range, 184 to 38wk). The ratio of male : female was 16 : 10, mean weight was 1.76±0.88Kg, Apgar score at 5min was 6.9, and type of delivery was C-section : vaginal delivery 19 : 4. Before and after, 10, 30min, 1, 6, l2hr, 1, 3, 5, 7days after surfactant administration, peak systolic and end-diastolic flow velocity(PSFV, EDFV) were estimated by Doppler method measuring MCA flow velocity. The Resistive index was calculated according to the mathematics. For the evaluation of the clinical status, systolic and diastolic systemic BP, PaO2, PaCO2, FiO2, pH, and respiratory rate(RR) were checked.
The cerebral blood flow velocity showed initial increase of PSFV just after synthetic surfactant administration, and the increased PSFV continued until the 30 minites and then decreased. PSFV returns to initial level at 6hr, and then increased again. The changes of EDFV was not significant. The changes of RI & PI were no significant changes. The effects of surfactant to the systemic BP had no significance. The changes of PaCO2 and PaO2 were not significant. FiO2 showed steady improvement. Initial tachypnea and acidosis progressively improved without clinical significance.
The administration of Surfactant in the HMD patients results in transient increase of cerebral blood flow velocity.
, Jae Jin Han, Yong Soon Won Inflammatory reaction is the one of deteriorating causes of pulmonary function after cardiopulmonary bypass. And leukocytes play a major role in inflammatory reaction by producing cytotoxic oxygen free radicals, initiating complement cascade, and so on. We tested the hypothesis that reducing the circulating leukocyte by using leukocyte poor RBC(LPR) in priming solution, and low-dose aprotinin which reduces whole body inflammatory response can reduce inflammatory reaction and results in less release of cytokines and preserving better pulmonary function after cardiopulmonary bypass.
In a prospective, randomized study, 23 children undergoing open heart surgery were investigated. LPR was used in 8 patients(group 1), 8 patients received low-dose aprotinin(50,000 KIU per body weight in priming solution, group 2) and 7 patients were control group (group 3). Patients with complex heart diseases, body weight over 10kg, palliative surgery, and residual defect after surgery were excluded from this study. CBC, interleukin 6, and granulocyte elastase were analyzed after 60 minutes of cardiopulmonary bypass, and (A-a)DO2(alveolar arterial oxygen difference) was measured postoperatively.
There was no statistically significant difference in interleukin 6 level, granulocyte elastase level, (A-a)DO2, intubation period, mortality, pulmonary complication, and WBC count at postoperative 1st day.
Our results suggested that LPR in priming solution and low-dose aprotinin have little influence on the inflammatory reaction and pulmonary function deterioration caused by cardiopulmonary bypass. Although LPR in priming solution can reduce circulatory leukocyte, the leukocytes increase rapidly after initiation of cardiopulmonary bypass, so that reducing leukocytes by LPR use has little influence on the inflammatory reaction.
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