• Kidney Research and Clinical Practice
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• v.37 no.4
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• pp.315-322
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• 2018

The high mortality rates associated with acute kidney injury are mainly due to extra-renal complications that occur following distant-organ involvement. Damage to these organs, which is commonly referred to as multiple organ dysfunction syndrome, has more severe and persistent effects. The brain and its sub-structures, such as the hippocampus, are vulnerable organs that can be adversely affected. Acute kidney injury may be associated with numerous brain and hippocampal complications, as it may alter the permeability of the blood-brain barrier. Although the pathogenesis of acute uremic encephalopathy is poorly understood, some of the underlying mechanisms that may contribute to hippocampal involvement include the release of multiple inflammatory mediators that coincide with hippocampus inflammation and cytotoxicity, neurotransmitter derangement, transcriptional dysregulation, and changes in the expression of apoptotic genes. Impairment of brain function, especially of a structure that has vital activity in learning and memory and is very sensitive to renal ischemic injury, can ultimately lead to cognitive and functional complications in patients with acute kidney injury. The objective of this review was to assess these complications in the brain following acute kidney injury, with a focus on the hippocampus as a critical region for learning and memory.

• Biomedical Science Letters
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• v.16 no.3
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• pp.139-149
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• 2010

The present study was carried out to elucidate whether an environmental strain of Cryptococcus neoformans (environmental C. neoformans) isolated from an environmental source in a park of Busan has an acute pathophysiological effect in rats. On the second day after peritoneal inoculation of environmental C. neoformans, adverse effects occurred from the viewpoint of hematology and biochemistry. Eosinophil damages and crystal formations were found in the blood. Disturbances in cytokines production were observed in the cerebral and pulmonary tissues. Fungal budding existed in the brain, lung, liver and kidney. Tissue injury findings such as inflammation, leukocyte infiltration, bleeding, or degeneration were found in the brain, lung, liver and kidney. The present data suggest that the environmental C. neoformans can cause systematically harmful effects even for short periods of infection (two days of cryptococcal infection) and the adverse effects are summarized as immune derangements and biochemical and/or histological dysfunction and injury on major organ such as the brain, lung, liver and kidney in the immunocompetent hosts. Further studies should be focused on comparing the differences between environmental and clinical strains of C. neoformans.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.888-895
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• 1998

Malaria is one of the most common infectious diseases in the world. Plasmodium falciparum, accounting for nearly all malaria mortality, kills an estimated 1 to 2 million persons yearly and has several features that make it deadlist of malarias. While cerebral malaria is the most common presentation of severe disease, acute lung injury associated with malaria is uncommon but serious and fatal complication. We report two cases of severe malaria with ARDS and multi-organ failure. All two patients traveled to foreign countries, Kenya, Papua New Guinea where choroquine-resistant malaria is distributed. The first case, which developed cerebral malaria, hypoglycemia, multi-organ failure, and ARDS, treated with quinine and mechanical ventilator, but expired due to oxygenation failure. Autopsy showed acute necrotizing infiltration, diffuse eosinophilic fibrinoid deposits along the alveolar space, and alveolar macrophage with malaria pigment The second case also developed multi-organ failure, followed by ARDS, and was treated with quinine, exchange transfusion, plasmapheresis, and mechanical ventilator. He recovered with residual restrictive lung change after treatment.

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.75-78
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• 2019

It is difficult to differentiate acute skin failure (ASF) from pressure ulcer (PU). ASF is defined as unavoidable injury resulting from hypoperfusion caused by severe dysfunction of another organ system. We describe a case of ASF mistaken as PU that resulted in a legal dispute. A 74-year-old male patient was admitted to our intensive care unit with sepsis due to bacterial pneumonia. Despite the use of air cushions and regular position changes, skin ulcerations occurred over his occiput, back, buttock, elbow, and ankle. After improvement in his general condition, he was transferred to the department of plastic and reconstructive surgery. Debridement was performed immediately, followed by conservative treatment (including a vacuum-assisted closure device) for 6 weeks. The buttock and occiput wounds were treated surgically. Despite complete healing, his caregivers sued the hospital for failing to prevent PU formation. ASF is a pressure-related injury resulting from hemodynamic instability due to organ system failure. Unlike PU, ASF may occur despite the implementation of all appropriate preventive measures. Furthermore, misdiagnosis of ASF as PU can lead to litigation. Therefore, it is critical for the proper diagnosis to be made quickly, and for physicians to explain that ASF occurs despite proper preventative treatment.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.155-158
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• 2011

Mechanical ventilation is usually the treatment of choice for severe respiratory failure associated with trauma. However, in case of severe hypoxia, mechanical ventilation may not be sufficient for gas exchange in lungs. Patients with Acute Respiratory Distress Syndrome (ARDS) undergo difficulties in oxygen and carbon dioxide exchange. Extracorporeal Membrane Oxygenation (ECMO) is the ideal therapeutic option for those patients with severe traumatic injuries. ECMO allows lungs to reserve their functions and decreases further lung injuries while increasing survival rate at the same time. We report two cases of patients with traumatic ARDS and Multiple Organ Failure including compromised heart function. The preservation of lung function was successful using ECMO therapy.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.418-423
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• 1979

Chest injuries due to blunt trauma often result in severe derangements that lead to death. And we have to diagnose and treat the patients who have blunt chest trauma immediately and appropriately. A clinical analysis was made on 324 cases of chest injury due to blunt trauma experienced at department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyung Hee University during 8-year period from 1972 to 1979. Of 324 patients of blunt chest injuries, there were 189 cases of rib fracture, 121 of hemothorax or/and pneumothorax, 108 of soft tissue injury of the chest wall only, 41 of lung contusion, 24 of flail chest, 13 of scapular fracture, 7 of diaphragmatic rupture and others. The majority of blunt chest injury patients were traffic accident victims and falls accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 3rd decade and 4th decade [60%] and 238 patients were male comparing to 86 of female [Male: Female = 3:1 ]. In the patients who have the more number of fractured ribs, the more incidence of intrathoracic injury and intraabdominal organ damage were found. The principal associated injuries were head injury on 58 cases, long bone fractures on 37, skull fractures on 12, pelvic fractures on 10, renal injuries on 6 and intraabdominal organ injuries on 5 patients. The principle of early treatment of chest injury due to blunt trauma were rapid reexpansion of the lung by closed thoracotomy which was indicated on 96 cases, but open thoractomy was necessary on 14 cases because massive bleeding, intrapleural hematoma and/or fibrothorax, or diaphragmatic laceration-On 15 cases who were young and have multiple rib fracture with severe dislocation delayed elective open reduction of the fractured ribs with wire was done on the purpose of preserving normal active life. The over all mortality was 2.8% [9 of 324 cases] due to head injury on 3 cases, massive bleeding on 2,wet lung syndrome, acute renal failure on 1 and septicemia on 1 patient.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.414-421
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• 1982

200 patients admitted to the Chest Surgery Department of Jeonbug National University Hospital from January, 1974 to December, 1981 were analyzed clinically. The ratio of male to female was 7: 1, which showed male predominance. Distribution of patients according to age disclosed that over half [62%] of the patients was social age between 20 and 49 years. The most common cause of chest trauma was traffic accident [39%], and the next were stab wound, fall down [17.5%], and hit [8.5%] in decreasing order. Common lesions due to chest trauma were as follows; rib fracture [51%], hemopneumothorax, hemothorax, and pneumothorax in decreasing number. The most common cause of rib fracture was traffic accident [50%] and the associated organ injuries were long bone fracture, head injury, spine and pelvic bone fracture, spleen rupture, and liver laceration. Hemothorax, pneumothorax, and hemopneumothorax were treated with insertion of thoracic catheter in 90 cases, pure thoracentesis in 11 cases, and emergency thoracotomy in 11 cases. In flail chest, 6 patients were treated by intramedullary insertion of Kirschner`s wire and the results were good. The incidence of complication was 17%, including atelectasis [11 cases], pyothorax, fibrothorax, pneumonia, and acute respiratory failure. Four patients were died [2%], and the causes were acute respiratory failure in 2 cases, spinal cord injury in one case and head injury in one case.

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.104-107
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• 2015

Purpose: Nitric oxide (NO) is a vasodilator and inhaled NO (iNO) is used in acute respiratory distress syndrome (ARDS) to improve alveolocapillary gas exchange. The mechanism to improve oxygenation is likely to redistribute blood flow from unventilated areas to ventilated areas. Though improvement of oxygenation, iNO therapy has not been shown to improve mortality and considered as only rescue therapy in severe hypoxemia. We conducted the study to investigate an efficacy of iNO in trauma patients with severe hypoxemia. Methods: We reviewed the trauma patients who underwent iNO therapy retrospectively from 2010 to 2014. Degree of hypoxemia was represented as $PaO_2/FiO_2$ ratio (PFR) and the severity of patient was represented with sequential organ failure assessment (SOFA) score. Patients were divided into the survivor group and non-survivor group according to the 28-day mortality. Results: A total of 20 patients were enrolled. The mortality of 28-day was 40%. There were no significant differences between survivor and non-survivor group in age, sex, severity of injury, PFR and SOFA score. There was significant difference in initiation time of iNO after injury (p=0.047). Maximum combinations of sensitivity and specificity for timing of iNO therapy were observed using cut-off of 3-day after injury with a sensitivity of 88% and specificity of 75%. Conclusion: Though iNO therapy does not influence the mortality, iNO therapy may decrease the mortality caused by respiratory failure in the early phase of trauma.

• Journal of Ginseng Research
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• v.46 no.3
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• pp.331-336
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• 2022

Coronavirus disease 2019 (COVID-19) exhibits various symptoms, ranging from asymptomatic to severe pneumonia or death. The major features of patients in severe COVID-19 are the dysregulation of cytokine secretion, pneumonia, and acute lung injury. Consequently, it leads to acute respiratory distress syndrome, disseminated intravascular coagulation, multiple organ failure, and death. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of COVID-19, influences nucleotide-binding oligomerization domain, leucine-rich repeat, and pyrin domain containing 3 (NLRP3), the sensor of inflammasomes, directly or indirectly, culminating in the assembly of NLRP3 inflammasome and activation of inflammatory caspases, which induce the inflammatory disruption in severe COVID-19. Accordingly, the target therapeutics for inflammasome has attracted attention as a treatment for COVID-19. Korean Red Ginseng (KRG) inhibits several inflammatory responses, including the NLRP3 inflammasome signaling. This review discusses the role of KRG in the treatment and prevention of COVID-19 based on its anti-NLRP3 inflammasome efficacy.

• BMB Reports
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• v.43 no.9
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• pp.629-634
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• 2010

Endotoxin including lipopolysaccharide (LPS) confers organ tolerance against subsequent challenge by ischemia and reperfusion (I/R) insult. The mechanisms underlying this powerful adaptive defense remain to be defined. Therefore, in this study we attempted to determine whether nitric oxide (NO) and its associated enzymes, inducible NOS (iNOS) and endothelial NOS (eNOS, a constitutive NOS), are associated with LPS-induced renal tolerance against I/R injury, using iNOS (iNOS knock-out) or eNOS (eNOS knock-out) gene-deleted mice. A systemic low dose of LPS pretreatment protected kidney against I/R injury. LPS treatment increased the activity and expression of iNOS, but not eNOS, in kidney tissue. LPS pretreatment in iNOS, but not eNOS, knock-out mice did not protect kidney against I/R injury. In conclusion, the kidney tolerance to I/R injury conferred by pretreatment with LPS is mediated by increased expression and activation of iNOS.