Non-Mitochondrial Aconitase-2 Mediates the Transcription of Nuclear-Encoded Electron Transport Chain Genes in Fission Yeast.

Aconitase-2 (Aco2) is present in the mitochondria, cytosol, and nucleus of fission yeast. To explore its function beyond the well-known role in the mitochondrial tricarboxylic acid (TCA) cycle, we conducted genome-wide profiling using the aco2ΔNLS mutant, which lacks a nuclear localization signal (NLS). The RNA sequencing (RNA-seq) data showed a general downregulation of electron transport chain (ETC) genes in the aco2ΔNLS mutant, except for those in the complex II, leading to a growth defect in respiratory-prone media. Complementation analysis with non-catalytic Aco2 [aco2ΔNLS + aco2(3CS)], where three cysteines were substituted with serine, restored normal growth and typical ETC gene expression. This suggests that Aco2's catalytic activity is not essential for its role in ETC gene regulation. Our mRNA decay assay indicated that the decrease in ETC gene expression was due to transcriptional regulation rather than changes in mRNA stability. Additionally, we investigated the Php complex's role in ETC gene regulation and found that ETC genes, except those within complex II, were downregulated in php3Δ and php5Δ strains, similar to the aco2ΔNLS mutant. These findings highlight a novel role for nuclear aconitase in ETC gene regulation and suggest a potential connection between the Php complex and Aco2.

Is it enough for COVID-19 screening test? Limitation of swab test and general characteristics of mild symptom patients.

The most common method for SARS-CoV-2 testing is throat or nasal swabbing by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. In South Korea, drive-through swab test is used for screening system and community treatment centers (CTCs), which admit and treat confirmed COVID-19 patients with mild symptoms, are being used. This retrospective study was conducted on patients admitted to a CTC on March 6, 2020. A total of 313 patients were admitted. The nasal and throat swabs were collected from the upper respiratory tract, and a sputum test was performed to obtain lower respiratory samples. The positive rate of the first set of test, sputum test was higher than that of the swab test (p = 0.011). In the second set of test, 1 week after the first ones, the rate of positive swab tests was relatively high (p = 0.026). In the first set of test, 66 of 152 (43.4%) patients showed 24-h consecutive negative swab test results, when the sputum test results were considered together, that number fell to 29 patients (19.1%) (p < 0.001). Also, in the second set of test, 63 of 164 (38.4%) patients met the discharge criteria only when the swab test was considered; that number fell to 30 (18.3%) when the sputum test results were also considered (p < 0.001). Using the swab test alone is insufficient for screening test and discharge decision. Patients who may have positive result in the sputum test can be missed.

Preventive effects of seat belts on traumatic brain injury in motor vehicle collisions classified by crash severities and collision directions.

PURPOSE: This study aimed to measure the preventive effect of seat belt on traumatic brain injury (TBI) and to compare the effect according to the crash severities and collision directions. METHODS: Korea In-Depth Accident Study (KIDAS) has collected vehicle and demographic data on injured occupants involved in motor vehicle collisions (MVCs) who visited three emergency medical centers for calendar years 2011-2016. Primary and secondary end points were TBI (abbreviated injury score 2+) and in-hospital mortality. Crush extent (CE) was classified into 1-2, 3-4, 5-6, and 7-9 according to the crash severity. We calculated adjusted odds ratios (ORs) of seat belts and CE for study outcomes and developed an interaction model in each collision direction using multivariate logistic regression analysis. RESULTS: Of the 2,245 occupants who were injured in MVCs, 295 (13.1%) occupants sustained TBI. In univariate analysis, old age, unbelted status, lateral collision, and higher CE were factors associated with TBI in MVCs. Occupants with belted status was less likely to have TBI and in-hospital mortality compared with those with unbelted status [AORs (95% CI) 0.48 (0.37-0.62) and 0.49 (0.30-0.81), respectively]. In interaction analysis, preventive effects of seat belts on TBI from MVCs were retained within CE 5-6 in frontal MVCs and within CE 1-2 in near side lateral MVCs, and those of seat belts on in-hospital mortality were reserved within CE 3-4 in frontal and rollover MVCs. CONCLUSIONS: The preventive effects of seat belts on TBI and in-hospital mortality are preserved within a limited crash severity in each collision direction.

Identification of perirenal or renal splenosis from undetermined masses: case report and review of the literature.

The incidental finding of tumor-llke perirenal or renal splenosis (PRS) creates a challenge to the renal physicians, because its benign nature has to be distinguished from a malignancy. This paper describes the case of a 40-year-old man referred from a local clinic for further evaluation of an incidental finding of left abdominal masses by ultrasonogram suspecting neoplasm, but was eventually confirmed as PRS by obtaining a history of splenectomy that pointed to splenosis and subsequently by a fusion image from single photon emission computed tomography using 99mTc-labelled heat-denatured erythrocytes and computed tomography (hybrid SPECT/CT). In addition, a review of 27 cases of PRS in a MEDLINE search including the present case revealed the following: all the masses were found incidentally and were associated with a history of previous splenectomy or splenic injury; the initial impressions were neoplastic tumor/PRS (n = 9), PRS (n = 10), and neoplastic tumor without consideration of splenosis (n = 8); surgical exploration was undertaken in all the 8 cases of suspected neoplastic tumor only, whereas non-invasive radiological or radionuclide imaging confirmed splenosis in the rest of the cases (n = 19). To avoid unnecessary tests and invasive surgery for undetermined perirenal or renal masses accompanying previous splenic injury, we stress the paramount importance of careful history-taking, physical examination, and a high index of suspicion for splenosis. Also, fusion imaging of hybrid SPECT/CT was reconfirmed as a useful diagnostic technique for accurately detecting and localizing splenic tissues by PRS.

Unintended cannulation of the subclavian artery in a 65-year-old-female for temporary hemodialysis vascular access: management and prevention.

Ultrasound-guided cannulation of a large-bore catheter into the internal jugular vein was performed to provide temporary hemodialysis vascular access for uremia in a 65-yr-old woman with acute renal failure and sepsis superimposed on chronic renal failure. Despite the absence of any clinical evidence such as bleeding or hematoma during the procedure, a chest x-ray and computed tomographic angiogram of the neck showed that the catheter had inadvertently been inserted into the subclavian artery. Without immediately removing the catheter and applying manual external compression, the arterial misplacement of the hemodialysis catheter was successfully managed by open surgical repair. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization with a large-bore catheter and to the management of its potentially devastating complications, since central vein catheterization is frequently performed by nephrologists as a common clinical procedure to provide temporary hemodialysis vascular access.

The effectiveness of hypertonic saline and pentoxifylline (HTS-PTX) resuscitation in haemorrhagic shock and sepsis tissue injury: comparison with LR, HES, and LR-PTX treatments.

PURPOSE: To compare lung and liver injury and laboratory results in haemorrhagic shock and sepsis models treated with combinations of lactated Ringer's solution (LR), 7.5% hypertonic saline (HTS), hydroxyethyl starch (HES), and pentoxifylline (PTX). METHODS: Male Sprague-Dawley rats (200-290 g) were assigned randomly to one of four treatment groups (n=16 per group): (1) LR; (2) HES; (3) LR-PTX; and (4) HTS-PTX. Each group was subdivided into (1) haemorrhagic shock (n=8) and (2) sepsis (n=8) model groups. A venous catheter was used to inject resuscitation fluids, and an arterial catheter was used to withdraw blood and monitor mean arterial pressure (MAP). Lung and liver histology, bronchoalveolar lavage (BAL) fluid, and cytokine levels were evaluated. RESULTS: The mean lung injury score was 1.7. At 24h after treatment, the total leucocyte count in the BAL fluid was significantly (p<0.05) higher with LR treatment (10 × 10(6) ± 0.8) than with other treatments in the sepsis model groups (HES, 6 × 10(6) ± 1.2; LR-PTX, 5 × 10(6) ± 1.5; HTS-PTX, 5 × 10(6) ± 0.6). The higher total leucocyte count after LR treatment was attributable to a greater increase in the number of neutrophils (17 ± 1.5%) compared with increases after the other treatments (HES, 6 ± 0.8%; LR-PTX, 10 ± 1.3%; HTS-PTX, 5 ± 0.4%). In the sepsis model groups, the total hepatic injury score was also significantly (p<0.05) higher with LR treatment (9.9 ± 0.5) than with the other treatments (HES, 6.7 ± 0.8; LR-PTX, 5.6 ± 0.7; HTS-PTX, 3.1 ± 0.9). This also occurred in the shock model (LR, 10.6 ± 2.1; HES, 5.8 ± 0.9; LR-PTX, 7.3 ± 0.9; HTS-PTX, 3.5 ± 0.9). As compared with LR treatment, HTS-PTX resuscitation resulted in a 49% decrease in TNF-α, 29% decrease in IL-1ß, and 58% decrease in IL-6 in the shock model at 24h (p<0.05), and the respective decreases were 45, 24, and 35% in the sepsis model (p<0.05). CONCLUSION: HTS-PTX was superior to HES, LR-PTX, and LR for treating shock and sepsis, and LR-PTX and HES gave better results than LR therapy alone.

Secondary amyloidosis associated with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Secondary amyloidosis can occur as a complication of chronic systemic inflammatory and infectious diseases. Until now there has been no report of secondary amyloidosis associated with MS. We report herein a case of renal biopsy-proven secondary amyloidosis in a patient with MS. CASE REPORT: A 41-year-old woman with MS was hospitalized due to aggravated quadriparesis and edema in both lower extremities. Laboratory findings showed nephrotic-range proteinuria and hypoalbuminemia. A percutaneous renal biopsy procedure was performed, the results of which revealed secondary amyloid-A-type amyloidosis associated with MS. CONCLUSIONS: This is the first report of secondary amyloidosis associated with MS.

Acute myeloid leukaemia presenting as faecal incontinence.

Epidural sacral nerve compression as an initial feature of leukaemia is a rare complication. The findings in a 16-year-old boy who presented to an emergency department with symptoms of faecal incontinence are reported herein. Radiological imaging demonstrated soft tissue masses in the sacral epidural space. The diagnosis of acute myeloid leukaemia was confirmed on bone marrow aspirate. The characteristics and management of extramedullary leukaemia are discussed.

Brain magnetic resolution imaging to diagnose bing-neel syndrome.

Radiologic findings of Bing-Neel syndrome, which is an extremely uncommon complication resulting from malignant lymphocyte infiltration into the central nervous system (CNS) in patients with Waldenström's macroglobulinemia (WM), have been infrequently reported due to extreme rarity of the case. A 75-year-old man with WM presented at a neurology clinic with progressive gait and memory disturbances, and dysarthria of 2 months duration. Cerebrospinal fluid and serum protein electrophoresis and immunofixation electrophoresis showed IgM kappa-type monoclonal gammopathy. Brain magnetic resonance imaging revealed multifocal, hyperintense lesions on T2 weighted-images. Brain diffusion-weighted imaging (DWI) demonstrated hyperintensities in cerebral and cerebellar lesions that appeared isointense on apparent diffusion coefficient maps, which were compatible with vasogenic edema. Although histologic analysis is a confirmative study to prove direct cell infiltration into the brain, brain MRI with DWI may be a good supportive study to diagnose Bing-Neel syndrome.

Orthostatic headache as the presenting symptom of cervical spine metastasis.

Orthostatic headache is a key symptom of intracranial hypotension; however, not all orthostatic headaches are caused by cerebrospinal fluid leaks leading to intracranial hypotension. We report here the unusual case of a 68-year-old man presenting with orthostatic headache in which compression of the C3 spinal nerve root by metastatic tumor invasion may contribute to the development of his orthostatic headache.

Clinical factors associated with brachial-ankle pulse wave velocity in patients on maintenance hemodialysis.

Pulse wave velocity (PWV) is a main parameter for arterial stiffness. In patients with end-stage renal disease (ESRD), PWV is known to be associated with increased mortality. But factors related to the increased PWV in ESRD patients are not well defined. In addition, the carotid-femoral PWV (cfPWV) measurement, which traditionally has been used to evaluate arterial stiffness, has low reproducibility. Recently, brachial-ankle PWV (baPWV) measurement, which can be performed more easily than cfPWV measurement, has become available as a means of measuring PWV. The aim of this study is to investigate the clinical factors associated with increased baPWV in ESRD patients. BaPWV was examined for 65 ESRD patients on maintenance hemodialysis during the period between the 7(th) to the 11(th) of February in 2005 using VP-1000. The clinical factors included age, sex, smoking history, blood pressure, diabetes, body mass index, interdialytic weight gain, duration of dialysis, lipid profile, uric acid, albumin, creatinine, C-reactive protein, calcium, phosphate, intact parathyroid hormone, and hematocrit were analyzed regarding associations (or to determine associations) with baPWV. The median age was 53.8±12.0, 31 males and 34 females. BaPWV was 18.9±5.2 m/s and there was no significant difference between gender (18.1±4.4 m/s vs 19.4±5.9 m/s, p=NS). In multiple regression models, age, predialysis systolic blood pressure, and diabetes were independent variables. In conclusion, age, systolic blood pressure, and diabetes were correlated with baPWV in ESRD patients. Thus baPWV measured by simple, noninvasive methods may become available for screening high risk groups in ESRD patients, although further longitudinal studies are necessary.

Persistent sciatic artery with monoplegia in right lower leg without vascular complication symptoms in an obese woman.

A rare case of a persistent sciatic artery (PSA) in a patient with monoplegia of the right lower leg without vascular complication symptoms is presented. A 44-year-old nervous and obese woman was referred with monoplegia of the right lower extremity. She was referred with an impression of a peripheral neuropathy due to nerve compression by a large uterine cyst. This impression was derived from a computed tomography (CT) scan that had been performed at the referring hospital the day before. On admission to our hospital, we repeated the CT scan and also obtained angiography that demonstrated that the problem was due to a persistent sciatic artery (PSA). The cyst was proved not to compress any vessels or nerves. The PSA was an aneurysmal dilatation from the internal iliac artery to the popliteal artery. It intermittently compressed the sciatic nerve. A persistent sciatic artery was noted to be the dominant blood supply to the right lower extremity. A right ilio-popliteal artery bypass using a 6-mm ringed ePTFE graft was performed. After arterial reconstruction, she recovered completely.

The effectiveness of the error reporting promoting program on the nursing error incidence rate in Korean operating rooms.

PURPOSE: The purpose of this study was to develop and evaluate an error reporting promoting program(ERPP) to systematically reduce the incidence rate of nursing errors in operating room. METHODS: A non-equivalent control group non-synchronized design was used. Twenty-six operating room nurses who were in one university hospital in Busan participated in this study. They were stratified into four groups according to their operating room experience and were allocated to the experimental and control groups using a matching method. Mann-Whitney U Test was used to analyze the differences pre and post incidence rates of nursing errors between the two groups. RESULTS: The incidence rate of nursing errors decreased significantly in the experimental group compared to the pre-test score from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in the 3 domains-"compliance of aseptic technique", "management of document", "environmental management" in the experimental group while it decreased in the control group which was applied ordinary error-reporting method. CONCLUSION: Error-reporting system can make possible to hold the errors in common and to learn from them. ERPP was effective to reduce the errors of recognition-related nursing activities. For the wake of more effective error-prevention, we will be better to apply effort of risk management along the whole health care system with this program.

Pseudohyperphosphatemia in a patient with multiple myeloma.

Hyperphosphatemia is an unusual manifestation in patients with multiple myeloma without a significantly reduced glomerular filtration rate. Serum phosphate may be falsely elevated when a large amount of paraproteins is present in the serum, because ultraviolet light absorbance is elevated with the phosphomolybdate ultraviolet assay, which is most commonly used for serum phosphate measurement. This pseudohyperphosphatemia can be confirmed by deproteinization of the serum of patients. We report a case of multiple myeloma presenting with spurious hyperphosphatemia revealing pseudohyperphosphatemia by deproteinization of serum using sulfosalicylic acid.

[A case of sarcomatoid hepatocellular carcinoma in a young female without risk factor].

A previously healthy 22-year-old woman was admitted with a complaint of right upper quadrant abdominal pain for 2 weeks. Her past history was not remarkable. On admission, HBsAg and anti-HCV were negative and alpha-FP was within normal range. Abdominal sonography and CT showed a mass in liver measuring 10 x 11 cm with features of central necrosis and hemorrhage. On 6th hospital day, hemoperitoneum developed suddenly. She underwent emergency laparotomy and trisegmentectomy. Intraoperative finding revealed a hemoperitoneum with a tumor filled with liquefied necrotic tissues. Microscopically, the tumor was mostly composed of pleomorphic spindle cells with abundant anastomosing vascular channels and partly composed of tumor cells with trabecular arrangement. On immunohistochemical staining, tumor cells reacted with cytokeratin and vimentin, while CD34 and hepatocyte staining revealed negative. She died 2 months after the operation. We report a case of rapidly deteriorated primary sarcomatoid hepatocellular carcinoma in a young female without any risk factor.

Epstein-Barr virus-associated Hodgkin's disease following renal transplantation.

Post-transplant lymphoproliferative disorders (PTLD) have been recognized as a complication of immunosuppression and occur with a reported incidence of 1 to 8% of recipients receiving solid organ transplantation. PTLD are classified into two major categories, polymorphic and monomorphic PTLD. The majority of the monomorphic PTLD cases are non-Hodgkin's lymphoma of B-cell origin. Hodgkin's disease is not part of the typical spectrum of PTLD; however, it has been rarely reported. We describe a case of Hodgkin's disease following renal transplantation. A 41-year-old man developed right cervical lymphadenopathy following renal transplantation 116 months previously for chronic renal failure of unknown origin. He had been taking cyclosporine, mycophenolate mofetil and prednisone. A lymph node biopsy revealed mixed cellularity Hodgkin's disease. Immunohistochemical staining was positive for CD30 and EBV-latent membrane protein-1. No other site of disease was identified. The immunosuppressive agents were reduced (mycophenolate mofetil was discontinued, cyclosporine dose reduced from 200 mg to 150 mg and prednisone continued at 5 mg). After 2 cycles of ABVD followed by radiation therapy (3600 cGy), he achieved complete remission.