Early and mid-term results of coronary endarterectomy: Influence of cardiopulmonary bypass and surgical techniques

Background: Coronary endarterectomy (CE) may be a good option for complete revascularization of diffuse coronary artery diseases, but it has not been widely used because the outcomes have not been definitively identified. This study aims to evaluate the mid-term clinical results of CE and compare the outcomes according to the use of cardiopulmonary bypass (CPB) and the surgical technique used. Methods: Between 2004 and 2014, 69 cases of CE were performed in 64 patients. We divided the pa­tients into two groups: 1) on-pump coronary artery bypass with coronary endarterectomy (ONCAB-CE) versus off-pump coronary artery bypass with coronary endarterectomy (OPCAB-CE), and 2) “open” versus “closed” surgical techniques. Operative mortality and major morbidity, were investigated includ­ing perioperative myocardial infarction (PMI), and overall survival. Results: Operative mortality was 4.7% (3/64), and no PMI was observed in the study. No statistical differences in operative mortality rate between the ONCAB-CE and OPCAB-CE groups were found (3.1% vs. 6.2%, p = 1.0) or between open versus closed techniques (6.7% vs. 2.9%, p = 0.6). The incidence of major morbidity including cerebrovascular accident, atrial fibrillation, acute renal failure, mediastinitis, respiratory complications, and bleeding was comparable between all groups. There were seven late mortalities, and no differences were found in overall survival rate between all groups. Conclusions: Coronary endarterectomy appears to be a safe option for patients with diffuse coronary artery disease, regardless of whether CPB or a specified selection of surgical techniques are used

Experimental Study on Reinforced Concrete Column Incased in Prefabricated Permanent Thin-Walled Steel Form

Conventional construction methods of reinforced concrete (RC) structures generally require a long construction period and high costs due to many on-site temporary form works. In this study, a prefabricated permanent thin-walled steel form integrated with reinforcement cage (PPSFRC) was developed, and it makes for a fast-built construction by reducing the temporary form works. Axial compression tests were conducted on a total of 9 test specimens to investigate the structural performances of the newly developed columns. The proposed column construction method utilized relatively thinner steel plates compared to conventional concrete-filled tube (CFT) columns, but it was designed to have sufficient resistance performances against the lateral pressure of fresh concrete and to prevent the buckling of the thin plates by utilizing the steel angles and channel stiffeners prefabricated in the permanent thin-walled steel form. The experimental results showed that the column specimens fabricated by the PPSFRC method had better local buckling resistance and behaved in a more ductile manner compared to the conventional CFT columns. In addition, the axial strengths of the test specimens were compared with those estimated by design provisions, and the flexural moments induced by initial imperfection or accidental eccentricity of axial loads were also discussed in detail

An Insufficient Preoperative Diagnosis of Borrmann Type 4 Gastric Cancer in Spite of EMR

Borrmann type 4 gastric cancers are notorious for the difficulty of finding cancer cells in the biopsy samples obtained from gastrofiberscopy. It is important to obtain the biopsy results for making surgical decisions. In cases with Borrmann type 4 gastric cancer, even though the radiological findings (such as an upper gastrointestinal series, abdominal computed tomography and positron emission tomography/computed tomography) or the macroscopic findings of a gastrofiberscopy examination imply a high suspicion of cancer, there can be difficulty in getting the definite pathologic results despite multiple biopsies. In these cases, we have performed endoscopic mucosal resection under gastrofiberscopy as an alternative to simple biopsies. Here we report on a case in which no cancer cells were found even in the endoscopic mucosal resection specimen, but the radiologic evidence and clinical findings were highly suspicious for gastric cancer. The patient finally underwent total gastrectomy with lymph node resection, and she was pathologically diagnosed as having stage IV gastric cancer postoperatively

Bilateral upper lobe pulmonary edema during gynecologic laparoscopic surgery in the Trendelenberg position -A case report-

A 25-year-old woman was diagnosed with a ruptured ectopic pregnancy. During laparoscopic surgery, the patient was in the Trendelenberg position (20° degrees). Massive froth in the endotracheal tube was observed at the end of surgery. A portable chest x-ray, checked at the end of the operation, showed diffuse haziness in both upper lung fields. After one hour of aggressive treatment with drugs and positive mechanical ventilation, the amount of froth in the endotracheal tube was reduced considerably. Considering the symptom and radiologic findings, we concluded that diffuse bilateral upper lung field haziness was due to atypical pulmonary edema. We speculated that the rapid improvement of pulmonary edema was due to redistribution of fluid to the lowest part of lung by immediate reversing the patient's Trendelenberg position, along with aggressive treatment

Normal Ambulatory 24-Hour Esophageal pH Values in Koreans -A Multicenter Study-

Ambulatory 24-hr esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to establish normal values for gastroesophageal acid exposure in healthy Koreans. Fifty healthy volunteers (24 males and 26 females; mean age, 45 yr) without reflux symptoms and without reflux esophagitis or hiatal hernia on upper endoscopy underwent ambulatory 24-hr esophageal pH monitoring after esophageal manometry. The 95th percentiles for the reflux parameters were: the percent total time pH <4, 3.7%; the percent upright time pH <4, 5.7%; the percent supine time pH <4, 1.0%; the number of reflux episodes with pH <4, 76.5; the number of reflux episodes with pH <4 for >5 min, 1.5; the duration of the longest episode, 12.5 min; and the composite score, 14.2. Age and gender were not associated with any of the pH parameters. In conclusion, physiological gastroesophageal reflux occurs in healthy Koreans. These normal esophageal pH values will provide reference data for clinical and research studies in Korea

Complexity analysis of the stock market

We study the complexity of the stock market by constructing $\epsilon$-machines of Standard and Poor's 500 index from February 1983 to April 2006 and by measuring the statistical complexities. It is found that both the statistical complexity and the number of causal states of constructed $\epsilon$-machines have decreased for last twenty years and that the average memory length needed to predict the future optimally has become shorter. These results support that the information is delivered to the economic agents and applied to the market prices more rapidly in year 2006 than in year 1983.Comment: 9 pages, 4 figure

CTCF cooperates with CtIP to drive homologous recombination repair of double-strand breaks

The pleiotropic CCCTC-binding factor (CTCF) plays a role in homologous recombination (HR) repair of DNA double-strand breaks (DSBs). However, the precise mechanistic role of CTCF in HR remains largely unclear. Here, we show that CTCF engages in DNA end resection, which is the initial, crucial step in HR, through its interactions with MRE11 and CtIP. Depletion of CTCF profoundly impairs HR and attenuates CtIP recruitment at DSBs. CTCF physically interacts with MRE11 and CtIP and promotes CtIP recruitment to sites of DNA damage. Subsequently, CTCF facilitates DNA end resection to allow HR, in conjunction with MRE11-CtIP. Notably, the zinc finger domain of CTCF binds to both MRE11 and CtIP and enables proficient CtIP recruitment, DNA end resection and HR. The N-terminus of CTCF is able to bind to only MRE11 and its C-terminus is incapable of binding to MRE11 and CtIP, thereby resulting in compromised CtIP recruitment, DSB resection and HR. Overall, this suggests an important function of CTCF in DNA end resection through the recruitment of CtIP at DSBs. Collectively, our findings identify a critical role of CTCF at the first control point in selecting the HR repair pathway