Congenital Hemidiaphragmatic Agenesis Presenting as Reversible Mesenteroaxial Gastric Volvulus and Diaphragmatic Hernia: A Case Report

A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia

Recurrent Catecholamine-Induced Cardiomyopathy in a Patient With a Pheochromocytoma

Pheochromocytomas presents with variable clinical manifestations. Cardiomyopathy caused by a pheochromocytoma is well known. We report the case of a 62-year-old woman with recurrent left ventricular dysfunction, who was subsequently found to have a pheochromocytoma. The patient had two different patterns of cardiomyopathy. Patients with a cardiomyopathy, of non-specific origin, should have a pheochromocytoma ruled out

Enhancement of Nutrient Removal in a Hybrid Constructed Wetland Utilizing an Electric Fan Air Blower with Renewable Energy of Solar and Wind Power

The sewage treatment efficiency of hybrid constructed wetlands (CWs) was evaluated under different ventilation methods. The removal efficiencies of biochemical oxygen demand (BOD), total nitrogen (TN), and total phosphorus (TP) in the vertical flow- (VF-) horizontal flow (HF) CWs using an electric fan air blower by the renewable energy of solar and wind power were higher than those by natural ventilation, excluding only suspended solids (SS). The TN treatment efficiency in the CW using the air blower especially increased rapidly by 16.6% in comparison with the CW employing natural ventilation, since the VF bed provided suitable conditions (aerobic) for nitrification to occur. The average removal efficiencies of BOD, SS, TN, and TP in the effluent were 98.8, 97.4, 58.0, and 48.3% in the CW using an electric fan air blower, respectively. The treatment performance of the CWs under different ventilation methods was assessed, showing TN in the CW using an electric fan air blower to be reduced by 57.5~58.6% for inlet TN loading, whereas reduction by 19.0~53.3% was observed in the CW with natural ventilation. Therefore, to increase the removal of nutrients in CWs, an improved ventilation system, providing ventilation via an electric fan air blower with the renewable energy, is recommended

Gene Expression Profiling of Breast Cancers with Emphasis of β-Catenin Regulation

To gain molecular understanding of carcinogenesis of breast cancer, gene expression profiles were analyzed using cDNA microarray representing 4,600 cDNAs in 10 breast cancer samples and the adjacent noncancerous breast tissues from the same patients. The alterations in gene expression levels were confirmed by reverse-transcription PCR in four randomly selected genes. Genes that were differently expressed in cancer and noncancerous tissues were identified. 106 (of which 55 were known) and 49 (of which 28 were known) genes were up- or down-regulated, respectively, in greater than 60% of the breast cancer samples. In cancer tissues, genes related to cell cycle, transcription, metabolism, cell structure/motility and signal transduction were mostly up-regulated. Furthermore, three cancer tissues showing immunohistochemically aberrant accumulation of β-catenin in the nucleus and/or cytoplasm revealed down-regulation of Siah and Axin genes and up-regulation of Wnt and c-myc genes. These findings were highly consistent with Wnt signaling pathway associated with β-catenin regulation previously suggested by others. Our studies, therefore, provide not only a molecular basis to understand biological processes of breast cancer but also useful resources to define the mechanism of β-catenin expression in tumorigenesis of breast cancer

Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus

Background Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among acute HF patients. Methods A total of 1740 patients from the Korean Acute Heart Failure registry with DM were included in this study. The risk of all-cause mortality according to insulin therapy was assessed using the Cox proportional hazard models with inverse probability of treatment weighting to balance the clinical characteristics (pretreatment covariates) between the groups. Results DM patients had been treated with either oral hypoglycemic agents (OHAs) alone (n = 620), insulin alone (n = 682), or insulin combined with OHAs (n = 438). The insulin alone group was associated with an increased mortality risk compared with the OHA alone group (HR = 1.41, 95 % CI 1.21–1.66]). Insulin therapy combined with OHAs also showed an increased mortality risk (HR = 1.29, 95 % CI 1.14–1.46) compared with the OHA alone group. Insulin therapy was consistently associated with increased mortality risk, regardless of the left ventricular ejection fraction (LVEF) or HF etiology. A significant increase in mortality was observed in patients with good glycemic control (HbA1c < 7.0 %) receiving insulin, whereas there was no significant association in patients with poor glycemic control (HbA1c ≥ 7.0%). Conclusions Insulin therapy was found to be associated with increased mortality compared to OHAs. The insulin therapy was harmful especially in patients with low HbA1c levels which may suggest the necessity of specific management strategies and blood sugar targets when using insulin in patients with HF.This study was supported by the Research of Korea Centers for Disease Control and Prevention (2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013E63003-00, 2013-E63003-01, 2013-E63003-02, and 2016-ER6303-00

Image Processing for Sustainable Remodeling: Introduction to Real-time Quality Inspection System of External Wall Insulation Works

The external wall insulation method was introduced to enhance the energy efficiency of existing buildings. It does not cause a decrease of inner space and costs less in comparison to methods that insert insulation panels inside walls. However, it has been reported that external wall insulation boards are disconnecting from walls due to malfunctions of the adhesive. This causes not only repair costs, but also serious injury to pedestrians. Separation problems occur when the bonded positions are incorrect and/or the total area and thickness of the adhesive is smaller than the required amount. A challenge is that these faults can hardly be inspected after installing boards. For this reason, a real-time inspection system is necessary to detect potential failure during adhesive works. Position, area and thickness are major aspects to inspect, and thus a method to process image data of these seems efficient. This paper presents a real-time quality inspection system introducing image processing technology to detect potential errors during adhesive works of external wall insulation, and it is predicted to contribute to achieving sustainable remodeling construction by reducing squandered material and labor costs. The system consists of a graphic data creation module to capture the results of adhesive works and a quality inspection module to judge the pass or fail of works according to an algorithm. A prototype is developed and validated against 100 panels with 800 adhesive points

Clinical Characteristics of Subjects with Sulfonylurea-Dependent Type 2 Diabetes

BackgroundEven though several oral anti-diabetic drugs (OAD) with various modes of action are replacing sulfonylurea (SU), some patients seem to be dependent on SU for adequate glycemic control. Therefore, we evaluated the clinical characteristics of such patients.MethodsWe selected the patients with type 2 diabetes who met following criteria from 2009 to 2014 at Seoul National University Hospital: glycated hemoglobin (HbA1c) was maintained below 7.5% for at least 6 months under small dose of SU (glimepiride ≤2 mg/day or equivalent dose); after discontinuation of SU, HbA1c increased ≥1.2% within 3 months or ≥1.5% within 6 months; and after resuming SU, HbA1c reduction was ≥0.8% or reduction of fasting plasma glucose was ≥40 mg/dL within 3 months. Patients with impaired hepatic or renal function, and steroid users were excluded.ResultsNineteen subjects were enrolled: after averaged 4.8±1.5 months of SU-free period, HbA1c increased from 6.7%±0.4% to 8.8%±0.8% even though adding other OAD such as gliptins. However, HbA1c decreased to 7.4%±0.7% after resuming SU within 2.4±0.8 months. There was no sexual predominance. Despite their old age (67±11 years) and long duration of diabetes (18±10 years), fasting C-peptide was relatively well-reserved (3.9±2.6 ng/mL), and nephropathy was not observed (albumin-creatinine ratio 21.2±16.6 mg/g and estimated glomerular filtration rate 75.8±18.0 mL/min/1.73 m2). Strong family history was also noted (73.7%).ConclusionDespite hypoglycemia risk of SU, it seemed indispensable for a subset of patients with regard to insulin secretion. Genetic influences would be evaluated

Genetic variation of IL13 as a risk factor of reduced lung function in children and adolescents: A cross-sectional population-based study in Korea

Background: Previous investigations have suggested that genetic variations are associated with reduced lung function in early childhood. This study was conducted to evaluate the association between IL13 + 2044G -> A, the functionally relevant single nucleotide polymorphism (SNP) in the gene coding IL13, and lung function in early childhood. Patients and methods: A total of 1900 subjects aged 10-18 years living in Korea, were randomly recruited. Lung function test and methacholine bronchial provocation test were performed. Multiple regression analysis adjusting for sex, age, height, atopy, and history of passive smoking was done to evaluate effect of IL13 + 2044G -> A on lung function. Results: Mean (SD) forced expiratory volume in 1s (FEV(1)) was 2.66 L (+/- 0.60) in subjects with the AA or AG genotype (n = 982) and 2.75 L (+/- 0.57) in subjects with the GG genotype In = 918). IL13 + 2044G -> A showed a significant association with FEV(1) [in the minor allele dominant model (GG vs. AG + AA), P A remained still significant in subgroup analysis according to the presence of AHR (P A in both groups (P A is significantly associated with a reduced lung function in Korean children and adolescents. (C) 2008 Elsevier Ltd. All rights reserved.This work was supported by the Korea Health 21 R&D Project Grant 03-PJ10-PG13-GD01-0002 and the Clinical Research Center for Chronic Obstructive Airway Disease Grant 0412-CR03-0704-0001from the Korean Ministry of Health and Welfare.Sadeghnejad A, 2008, RESP RES, V9, DOI 10.1186/1465-9921-9-2Leung TF, 2007, CLIN EXP ALLERGY, V37, P1480, DOI 10.1111/j.1365-2222.2007.02799.xStern DA, 2007, LANCET, V370, P758Kim JJ, 2007, EUR ARCH OTO-RHINO-L, V264, P395, DOI 10.1007/s00405-006-0204-xPark HW, 2006, J ALLERGY CLIN IMMUN, V117, P774, DOI 10.1016/j.jaci.2005.12.1328Ober C, 2006, GENES IMMUN, V7, P95, DOI 10.1038/sj.gene.6364284Kim HB, 2006, J HUM GENET, V51, P1055, DOI 10.1007/s10038-006-0061-xSimpson A, 2005, AM J RESP CRIT CARE, V172, P55, DOI 10.1164/rccm.200412-1708OCVladich FD, 2005, J CLIN INVEST, V115, P747, DOI 10.1172/JCI200522818Hegab AE, 2004, CHEST, V126, P1832Chen WG, 2004, J ALLERGY CLIN IMMUN, V114, P553, DOI 10.1016/j.jaci.2004.04.044Khoo SK, 2004, J ALLERGY CLIN IMMUN, V113, P475, DOI 10.1016/j.jaci.2003.10.043Han W, 2004, CLIN CANCER RES, V10, P124Jakubzick C, 2004, IMMUNOL RES, V30, P339Elias JA, 2003, CHEST, V123, p339SHe JQ, 2003, AM J RESP CELL MOL, V28, P379, DOI 10.1165/rcmb.4885Kraan TCTMV, 2002, GENES IMMUN, V3, P436Belperio JA, 2002, AM J RESP CELL MOL, V27, P419, DOI 10.1165/rcmb.2002-00089OCKim YK, 2002, CLIN EXP ALLERGY, V32, P1305, DOI 10.1046/j.1365-2745.2002.01478.xKumar RK, 2002, CLIN EXP ALLERGY, V32, P1104Rasmussen F, 2002, AM J RESP CRIT CARE, V165, P1480, DOI 10.1164/rccm.2108009Zhu Z, 2001, AM J RESP CRIT CARE, V164, pS67Grol MH, 1999, AM J RESP CRIT CARE, V160, P1830ULICK CS, 1999, AM J RESP CRIT CARE, V160, P401993, EUR RESP J, V16, P1SHERRILL D, 1992, PEDIATR PULM, V13, P78PEAT JK, 1991, AM REV RESPIR DIS, V144, P663REDLINE S, 1989, AM REV RESPIR DIS, V140, P179