Prognostic Factors for Pulmonary Fibrosis Following Pneumonia in Patients with COVID-19: A Prospective Study.

The frequency and clinical manifestation of lung fibrosis accompanied by coronavirus disease (COVID-19) are not well-established. We aimed to identify the factors attributed to post-COVID-19 fibrosis. This single-center prospective study included patients diagnosed with COVID-19 pneumonia from 12 April to 22 October 2021 in the Republic of Korea. The primary outcome was the presence of pulmonary fibrosis on a CT scan 3 months after discharge; the fibrosis risk was estimated by a multiple logistic regression. The mean patient age was 55.03 ± 12.32 (range 27-85) years; 65 (66.3%) were men and 33 (33.7%) were women. The age, Charlson Comorbidity Index, lactate dehydrogenase level, aspartate aminotransferase level, and Krebs von den Lungen-6 level were significantly higher and the albumin level and the saturation of the peripheral oxygen/fraction of inspired oxygen (SpO2/FiO2) ratio were significantly lower in the fibrosis group than in the non-fibrosis group; the need for initial oxygen support was also greater in the fibrosis group. An older age (adjusted odds ratio (AOR) 1.12; 95% confidence interval (CI) 1.03-1.21) and a lower initial SpO2/FiO2 ratio (AOR 7.17; 95% CI 1.72-29.91) were significant independent risk factors for pulmonary fibrosis after COVID-19 pneumonia. An older age and a low initial SpO2/FiO2 ratio were crucial in predicting pulmonary fibrosis after COVID-19 pneumonia.

4-O-methylascochlorin, methylated derivative of ascochlorin, stabilizes HIF-1α via AMPK activation.

Chemopreventive or anticancer agents induce cancer cells to apoptosis through the activation of adenosine AMP-activated protein kinase (AMPK), which plays a major role as energy sensors under ATP-deprived condition or ROS generation. In this study, we compared the effects of ascochlorin (ASC), from the fungus Ascochyta viciae, and its derivatives on AMPK activity. We also examined a regulatory mechanism for hypoxia-inducible factor-1α (HIF-1α) stabilization in response to 4-O-methylascochlorin (MAC). We found that AMPK activation was mainly involved with MAC, but not ASC and 4-O-carboxymethylascochlorin (AS-6), indicating that the substitution of 4-O-methyl group from 4-O-hydroxyl group of ASC is important in the activation of AMPK and the expression of HIF-1α. MAC-stabilized HIF-1α via AMPK activation triggered by lowering the intracellular ATP level, not by ROS generation, increases glucose uptake and the expression of vascular endothelial growth factor (VEGF) and glucose transporter 1 (GLUT-1), major target genes of HIF-1α. Moreover, MAC-induced AMPK activity suppressed survival factors, including mTOR and ERK1/2 or translational regulators, including p70S6K and 4E-BP1. Our data suggest that AMPK is a key determinant of MAC-induced HIF-1α expression in response to energy stress, further implying its involvement in MAC-induced apoptosis.

Multidetector computed tomography findings of a papillary fibroelastoma of the aortic valve: a case report.

Papillary fibroelastoma is a rare benign cardiac tumor that represents 10% of all primary cardiac tumors. Diagnosis is accomplished incidentally by echocardiography that is usually performed for another purpose. Most papillary fibroelastomas are asymptomatic, but the lesions are recognized as a cause of embolisms. To the best of our knowledge, there has been no case report of computed tomography findings of a papillary fibroelastoma. We report a case of a papillary fibroelastoma in a 78-yr-old woman who had dyspnea and chest tightness. Echocardiography revealed a small lobulated mobile echogenic mass attached to the aortic valve, and CT demonstrated a lobulated soft tissue density mass with a thin stalk at the sinotubular junction of the aortic valve.

Renal artery embolization of perirenal hematoma in hemorrhagic fever with renal syndrome: a case report.

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization.

Nationwide Study of Humidifier Disinfectant Lung Injury in South Korea, 1994-2011. Incidence and Dose-Response Relationships.

RATIONALE: Humidifier disinfectant lung injury is an acute lung disease attributed to recurrent inhalation of certain disinfectant aerosols emitted from room humidifiers. An outbreak of this toxic lung injury occurred in South Korea from 1995 until all humidifier disinfectant products were recalled from the consumer market by the government in 2011. OBJECTIVES: A nationwide study was conducted to ascertain and classify all potential cases of humidifier disinfectant lung injury in Korea and to assess dose-response relationships. METHODS: By several mechanisms, clinicians and the general public were invited to report all suspected cases of humidifier disinfectant lung injury to public health officials in South Korea. A committee was convened to define diagnostic criteria based on pathologic, radiologic, and clinical findings for index cases, combined with assessment of environmental exposure to humidifier disinfectants. Clinical review and environmental assessments were performed and later combined to determine overall likelihood of disease for each study participant, classified as definite, probable, possible, or unlikely. Survival time from exposure to onset of symptoms was analyzed to assess dose-response relationships. Three broad categories of risk factors were examined: (1) biological susceptibility, (2) temporal cycle of exposure and recovery, and (3) spatial conditions and density of disinfectant. MEASUREMENTS AND MAIN RESULTS: Of 374 possible cases identified and reviewed, 329 were unanimously classified by the diagnostic committee, as follows: 117 definite, 34 probable, 38 possible and 140 unlikely cases. A total of 62 individuals with definite or probable disease died. Risk factors examined for polyhexamethyleneguanidine phosphate exposure that were found to be significant in shortening survival included age 4 years or younger at onset, use of disinfectant for 7 days per week, airborne density of 800 µg/m(3) or more of disinfectant, and daily exposure 11 or more hours in duration. CONCLUSIONS: Dose-response analysis indicated that development of humidifier disinfectant lung injury and death were associated strongly with recurrent, intense, acute exposure without sufficient recovery time between exposures, more so than long-term cumulative exposure. These findings may explain some reversible or clinically unapparent cases among coexposed family members.

Hepatic metastasis from choriocarcinoma: angiographic findings in two cases.

We report two cases of hepatic metastases from choriocarcinoma in women of childbearing age in whom imaging studies performed at presentation revealed the presence of liver masses, and who had clinically progressive anemia or intraabdominal hemorrhage. CT demonstrated heterogeneously enhanced liver masses. Characteristic angiographic findings included hypervascular hepatic masses with aneurysmal dilatations of the peripheral hepatic arteries at the arterial phase and persistent vascular lakes at the venous phase.

Paratracheal air cysts using low-dose screening chest computed tomography: clinical significance and imaging findings.

PURPOSE: The aim of this study was to evaluate the prevalence and clinical relevance of paratracheal air cysts in a general population who underwent low-dose computed tomography (LDCT). MATERIALS AND METHODS: From July 2005 to March 2008, a total of 2002 persons underwent LDCT and were included in the study. We retrospectively reviewed the chest CT images and analyzed the location, level, and size of the air cysts. We checked whether the cysts had communication with the trachea. Other abnormalities of the lung were noted. We evaluated whether the presence of paratracheal air cysts is associated with abnormal pulmonary function. RESULTS: In all, 75 persons (3.7%) had 77 paratracheal air cysts: 76 (98.7%) at the right side and 36 (46.7%) at the level of the T2 vertebral body. The mean anteroposterior diameter of the paratracheal air cysts was 7.5 mm, and mean transverse diameter was 4.2 mm. Altogether, 26 paratracheal air cysts (33.8%) showed communication with the trachea. Only two persons had respiratory symptoms. Pulmonary function tests showed that five patients (6.7%) had an obstructive pattern. CONCLUSION: The paratracheal air cysts were mostly located at the right side of the trachea and at the thoracic inlet level. One-third had communication with the trachea. Paratracheal air cysts are not associated with respiratory symptoms or obstructive lung disease clinically or radiologically.

Simultaneous emphysematous cholecystitis and emphysematous pancreatitis: a case report.

Emphysematous infections of the abdomen and pelvis are potentially life-threatening conditions that require aggressive medical and surgical management. Therefore, early radiographic detection of emphysematous infections is important in management. Emphysematous cholecystitis is a rare and severe form of acute cholecystitis caused by gas-forming organisms. Emphysematous pancreatitis is a rare form of pancreatitis with gas in pancreatic parenchyma. We report a rare case of simultaneous occurrence of emphysematous cholecystitis and emphysematous pancreatitis.

The protective effect of bee venom against ethanol-induced hepatic injury via regulation of the mitochondria-related apoptotic pathway.

Alcohol consumption increases apoptosis of hepatocytes. Death of hepatocytes is a characteristic feature of chronic liver disease for various causes. Bee venom (Apis mellifera) has been traditionally used for the treatment of various chronic diseases, such as chronic inflammatory arthritis and chronic liver disease. However, the precise mechanism for bee venom in chronic liver disease is not still cleared. To assess the effects of bee venom in chronic liver disease, we investigated the potential role of the bee venom in the ethanol-induced hepatocyte apoptosis. Bee venom treatment inhibited the apoptotic cell morphology and increased the cell viability in ethanol-induced hepatocyte apoptosis. With ethanol treatment, bee venom-treated hepatocytes increased activity of Bcl-2 and Bcl-xL, reduced activity of Bax, Caspase and PARP. In conclusion, bee venom treatment in ethanol-induced hepatocyte apoptosis occurred through the regulation of Bcl family with subsequent inactivation of the Caspase and PARP. These results suggest that bee venom could be an effective agent to reduce ethanol-induced hepatocyte apoptosis.

Bee venom reduces atherosclerotic lesion formation via anti-inflammatory mechanism.

The components of bee venom (BV) utilized in the current study were carefully scrutinized with chromatography. Despite its well documented anti-inflammatory property, there are no reports regarding the influence of BV on the expression of cellular adhesion molecules in the vascular endothelium. A great amount of information exists concerning the effects of an atherogenic diet on atherosclerotic changes in the aorta, but little is known about the molecular mechanisms and the levels of gene regulation involved in the anti-inflammatory process induced by BV. The experimental atherosclerosis was induced in mice by a lipopolysaccharide (LPS) injection and an atherogenic diet. The animals were divided into three groups, the NC groups of animals that were fed with a normal diet, the LPS/fat group was fed with the atherogenic diet and received intraperitoneal injections of LPS, and the LPS/fat + BV group was given LPS, an atherogenic diet and intraperitoneal BV injections. At the end of each treatment period, the LPS/fat + BV group had decreased levels of total cholesterol (TC) and triglyceride (TG) in their serum, compared to the LPS/fat group. The LPS/fat group had significant expression of tumor necrosis factor (TNF)-α and interleukin (IL)-1ß in the serum, compared with the NC group (p < 0.05). The amount of cytokines reduced consistently in the BV treatment groups compared with those in LPS/fat group. BV significantly reduced the amount of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), transforming growth factor-ß1 (TGF-ß1) and fibronectin in the aorta, compared with the LPS/fat group (p < 0.05). A similar pattern was also observed in the heart. In conclusion, BV has anti-atherogenic properties via its lipid-lowering and anti-inflammatory mechanisms.

Acetic acid sclerotherapy for treatment of a biliary leak from an isolated bile duct after hepatic surgery.

Bile duct leakage from the main biliary tree is not uncommon after hepatic surgery. In this case, successful percutaneous treatment was performed for bile leakage from an isolated bile duct after left hemihepatectomy in a 48-year-old woman who underwent surgery for biliary cystadenocarcinoma and developed a biloma at the left subphrenic space. Diagnostic procedures revealed that the right posterior segmental bile duct drained aberrantly into the left bile duct, which remained undrained after resection and led to biloma formation. Ablation of the isolated bile duct was performed with acetic acid, resulting in avoidance of repeated operation and other complications.

Covered metallic stent placement in the treatment of postoperative fistula resistant to conservative management after Billroth I operation.

A 55-year-old man presented with a case of postoperative enterocutaneous fistula with anastomotic stenosis after a Billroth I operation that was resistant to conservative treatment. This fistula was successfully treated with the placement of a covered metallic stent under fluoroscopic guidance. To our knowledge, this is the first report of postoperative enterocutaneous fistula that was successfully treated with a covered metallic stent.

Occlusion of the fallopian tube by selective transcatheter radiofrequency electrocoagulation: an experimental study in rabbits.

PURPOSE: To test the feasibility of performing transcervical fallopian tube occlusion in a rabbit model with use of unipolar radiofrequency (RF) electrocoagulation. MATERIALS AND METHODS: Under fluoroscopic guidance, transvaginal catheterization of the right or left fallopian tube was first performed with use of a coaxial technique in 20 rabbits. With a metal guide wire protruding from the catheter serving as the active electrode, RF electrocoagulation was performed. The power output was set to 200 W and the current was applied for 20 seconds. The fallopian tube on the contralateral side and the uterus were used as controls. Rabbits were randomly designated to be killed either 2 days (group I, n = 10) or 30 days (group II, n = 10) after the procedure, and tubal patency and histologic changes were evaluated. RESULTS: In group I, significant necrosis of the endosalpinx caused by RF electrocoagulation was found in all 10 rabbits. In group II, the occluded fallopian tube showed fibrosis of the wall in all 10 rabbits, but there was no tissue damage to adjacent organs. Histologic findings in the contralateral fallopian tubes were normal in all 20 rabbits. CONCLUSION: Transcatheter RF electrocoagulation proved to be a safe nonsurgical alternative for occlusion of the fallopian tubes in rabbits.

Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography.

OBJECTIVE: We prospectively evaluated transabdominal and transvaginal sonographic findings of patients with pelvic congestion syndrome and compared them with those of healthy volunteers. SUBJECTS AND METHODS. We examined 32 patients with pelvic congestion syndrome and 35 control subjects. Using transabdominal sonography, we evaluated the ovarian veins for diameter and flow direction, presence of pelvic varicocele, diameter of the pelvic veins, change of the duplex waveform during the Valsalva's maneuver, volume of the uterus, and presence of polycystic changes in the ovaries. We compared and statistically analyzed each parameter in the pelvic congestion syndrome group and in the control group. RESULTS: The mean (+/- SD) diameter of the left ovarian vein was 0.79 +/- 0.23 cm in the pelvic congestion syndrome group and 0.49 +/- 0.15 cm in the control group (p = 0.000). Reversed caudal flow in the left ovarian vein was present in 22 of 22 patients and in four of 16 control subjects. Pelvic varicoceles were present in all patients with pelvic congestion syndrome and in six control subjects. The mean diameter of the left pelvic vein was 0.68 +/- 0.21 cm in the pelvic congestion syndrome group and 0.42 +/- 0.19 cm in the control group; the mean diameter of the right pelvic vein was 0.64 +/- 0.24 cm in the pelvic congestion syndrome group and 0.35 +/- 0.14 cm in the control group (p = 0.000). Polycystic changes of the ovary were present in 13 patients with pelvic congestion syndrome (40.6%) and four control subjects (11.4%). CONCLUSION: Sonographic findings of pelvic congestion syndrome were dilated left ovarian vein with reversed caudal flow, presence of varicocele, dilated arcuate veins crossing the uterine myometrium, polycystic changes of the ovary, and variable duplex waveform during the Valsalva's maneuver. Combined transabdominal and transvaginal sonography are potentially useful as a noninvasive screening tool for determining which patients with chronic pelvic pain may benefit from selective ovarian venography and transcatheter embolization.