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BACKGROUND: Kidney transplantation is an effective renal replacement therapy for patients with end-stage renal disease (ESRD). In this study, we assessed the impact of the baseline characteristics and comorbidities of ESRD patients on the probability of deceased donor kidney transplantation (DDKT) and evaluated the morbidity and mortality during the time spent waiting. METHODS: The study population consisted of 544 ESRD patients on the waiting list for DDKT at Chungnam National University Hospital in South Korea between February 2000 and October 2015. The patients were observed from the date of transplantation list registration to the date of transplantation. Baseline characteristics and comorbidities were investigated together with new-onset comorbidities that occurred during the waiting time. RESULTS: Diabetes mellitus (39.0%), hypertension (25.2%), and glomerulonephritis (21.3%) were the three most common causes of ESRD in this study, and coronary artery disease (9.4%) was the most common comorbidity. The 115 patients (19.3%) who underwent DDKT had a mean waiting time of 1,711 days (768-2,654 days or 4.68 years [2.10-7.27]). Blood groups other than type O, peritoneal dialysis, and nondiabetic ESRD were significantly associated with a higher likelihood of DDKT. Infection was the leading cause of death and the most common comorbidity that arose during the waiting time. Patients who experienced cardiovascular events during the waiting time showed a lower transplant rate compared with those who did not. CONCLUSION: The prevalence of comorbidities was high in renal transplantation candidates. During the often-long waiting time, new comorbidities may occur, with long-term sequelae limiting access to kidney transplantation or resulting in death.

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BACKGROUND: The objective of the study was to evaluate the safety, technical feasibility, and complications of totally implanted venous access ports (TIVAPs) in the upper arm, for comparison with transjugular chest ports in patients with breast cancer. METHODS: In total, 223 consecutive female breast cancer patients who received a TIVAP in the upper arm or chest between July 2014 and February 2016 were included. All procedures were performed via a sonographic and fluoroscopic-guided approach using the Seldinger technique under local anesthesia. We reviewed the medical records to determine technical success, pain scale, and early (≤30 days) and late (>30 days) complications. RESULTS: In total, 231 devices were implanted in the upper arms (n = 176, 76%) and chests (n = 55, 24%) of the patients. The mean age was 51.6 ± 10.7 years (range 23-78 years; upper arm, 52.1 ± 11.0 years; chest, 50.1 ± 9.7 years, P > 0.05). The mean implantation time for TIVAPs was 181.7 ± 109.2 days (range, 9-460 days; upper arm 175.2 ± 102.7 days; chest, 202.4 ± 126.6 days, P > 0.05), with 41,974 catheter days. The technical success rate was 100%. Fourteen complications (6.1%) occurred in 14 patients (0.33/1,000 catheter days). There was no significant difference in complication-free survival for patients with upper arm TIVAPs and those with transjugular chest TIVAPs. The mean amount of 2% lidocaine, used as local anesthesia, was 3.3 ± 1.7 mL and 14.5 ± 4.1 mL for upper arm and chest TIVAPs, respectively. (P < 0.001). CONCLUSIONS: Implantation of TIVAPs in the upper arm is a safe procedure with a low rate of complications. Upper arm TIVAPs can be implanted with less pain compared with transjugular chest TIVAPs.

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BACKGROUND: Although hypothermia attenuates the renal injury induced by ischemia-reperfusion, the detailed molecular pathway(s) involved remains unknown. ERK phosphorylation is known to protect against ischemia-reperfusion injury. Also, it has been reported that hypothermia may induce ERK phosphorylation in the heart and brain. We evaluated the role played by ERK in hypothermic protection against renal ischemia-reperfusion injury. METHODS: C57Bl/6 mice were divided into the following groups: sham-operated (cold, 32°C) vs normal temperature (37°C); ischemia-reperfusion mice (32°C vs 37°C); and PD98059- or vehicle-treated ischemia-reperfusion mice (32°C). Kidneys were harvested 10 and 27 minutes after induction of renal ischemia and 24 hours after ischemia-reperfusion injury. Functional and molecular markers of kidney injury were evaluated. To explore the molecular mechanism involved the expression levels of renal HIF-1 and associated proteins were evaluated. RESULTS: The blood urea nitrogen (BUN) and serum creatinine (s-Cr) levels and the histologic renal injury scores were significantly lower in 32°C ischemia-reperfusion than 37°C ischemia-reperfusion kidneys (all P values < .05). The expression levels of Bax and caspase-3 and the extent of TUNEL and 8-OHdG cell positivity decreased, whereas the renal Bcl-2 level increased, in 32°C ischemia-reperfusion compared to 37°C ischemia-reperfusion mice. The extent of renal ERK phosphorylation was significantly higher in ischemia-reperfusion than sham-operated kidneys. Also, ERK phosphorylation was significantly increased in the kidneys of 32°C compared to 37°C ischemia-reperfusion mice. PD98059 treatment of 32°C ischemia-reperfusion mice significantly decreased the renal HIF-1 level (P < .05) and increased the BUN, s-Cr, renal Bax, and caspase-3 expression levels; the tissue injury score; and the proportions of TUNEL- and 8-OHdG-positive cells. PD98059 also increased the renal Bcl-2 level in such mice. CONCLUSION: Hypothermia attenuates the renal apoptosis and oxidative stress induced by ischemia-reperfusion via a mechanism involving ERK phosphorylation.

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BACKGROUND: Speckle-tracking echocardiography has been applied to measure right ventricular (RV) systolic function in various diseases. However, variations in strain measurement by different vendors have limited the application of these techniques for assessment of RV function. We sought to compare two methods for the assessment of RV systolic function in patients with acute pulmonary embolism (PE). METHODS: From August 2007 to May 2011, all consecutive PE patients were prospectively included in this cohort study. Global longitudinal strains of RV measured with EchoPAC PC software (GLSRV-EchoPAC; GE Medical Systems) and velocity vector imaging (GLSRV-VVI; Siemens Medical Systems) were recorded on the same set of echocardiographic images. RESULTS: We analyzed a total of 50 patients (12 males, 68 ± 14 years) with acute PE in this study. GLSRV-EchoPAC and GLSRV-VVI were correlated (r = 0.793, p < 0.001) and they showed significant correlations with conventional echocardiographic parameters of RV systolic function and Log B-type natriuretic peptide (BNP) level. However, GLSRV-VVI only showed significant correlations with cardiac biomarkers as serum creatinine kinase-MB (r = 0.367, p = 0.010) and tropoinin-I concentrations (r = 0.294, p = 0.040). CONCLUSION: GLSRV-VVI and GLSRV-EchoPAC showed significant correlations with conventional echocardiographic parameters of RV systolic function and LogBNP value in patients with PE.

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Overexpression/amplification of human epidermal growth factor receptor (HER)2/neu (erbB-2) oncogene plays a causal role in carcinogenesis and correlates with a poor clinical prognosis. However, little is known about HER2 in gastric cancer. In this study, we explored the pharmacological activities of natural triterpenoid corosolic acid (CRA) in HER2 signaling and its role in gastric cancer development and progression. In this study, CRA dramatically inhibited HER2 expression in a dose- and time-dependent manner, effectively inhibited cell proliferation, and induced G(0)/G(1) arrest through the induction of p27(kip1) and cyclin D(1) down-regulation. CRA exposure enhanced apoptotic cell death, as confirmed by caspase-3 and poly (ADP-ribose) polymerase cleavage activities. CRA inhibited signaling pathways downstream of HER2, including phospho-proteins such as Akt and Erk. In addition, CRA combined with adriamycin and 5-fluorouracil enhanced this growth inhibition, but not with docetaxel and paclitaxel. These findings demonstrate that CRA suppresses HER2 expression, which in turn promotes cell cycle arrest and apoptotic cell death of gastric cancer cells, providing a rationale for future clinical trials of CRA in the treatment of HER2-positive gastric cancers.

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Although transthoracic echocardiography (TTE) is the cornerstone of noninvasive cardiac imaging in the detection of cardiac source of emboli, transesophageal echocardiography (TEE) provides additional information for the identification of most causes. We report a case with a floating thrombus in the right coronary sinus of Valsalva, with complicated peripheral arterial embolism and renal infarct. Due to the high velocity of the blood flow, the formation of thrombus in the coronary sinus is extremely rare. This may, however, be a cause of embolism and a TEE examination should be included to detect potential cardiac source of embolism.

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