Circulating Extracellular-Vesicle-Incorporated MicroRNAs as Potential Biomarkers for Ischemic Stroke in Patients With Cancer / 대한뇌졸중학회지

Background@#and Purpose This study aimed to evaluate whether extracellular-vesicle-incorporated microRNAs (miRNAs) are potential biomarkers for cancer-related stroke. @*Methods@#This cohort study compared patients with active cancer who had embolic stroke of unknown sources (cancer-stroke group) with patients with only cancer, patients with only stroke, and healthy individuals (control groups). The expression profiles of miRNAs encapsulated in plasma exosomes and microvesicles were evaluated using microarray and validated using quantitative real-time polymerase chain reaction. The XENO-QTM miRNA assay technology was used to determine the absolute copy numbers of individual miRNAs in an external validation cohort. @*Results@#This study recruited 220 patients, of which 45 had cancer-stroke, 76 were healthy controls, 39 were cancer controls, and 60 were stroke controls. Three miRNAs (miR-205-5p, miR-645, and miR-646) were specifically incorporated into microvesicles in patients with cancer-related stroke, cancer controls, and stroke controls. The area under the receiver operating characteristic curves of these three miRNAs were 0.7692–0.8510 for the differentiation of patients with cancer-stroke from cancer-controls and 0.8077–0.8846 for the differentiation of patients with cancer-stroke from stroke controls. The levels of several miRNAs were elevated in the plasma exosomes of patients with cancer, but were lower than those in plasma microvesicles. An in vivo study showed that systemic injection of miR-205-5p promoted the development of arterial thrombosis and elevation of D-dimer levels. @*Conclusion@#Stroke due to cancer-related coagulopathy was associated with deregulated expression of miRNAs, particularly microvesicle-incorporated miR-205-5p, miR-645, and miR-646. Further prospective studies of extracellular-vesicle-incorporated miRNAs are required to confirm the diagnostic role of miRNAs in patients with stroke and to screen the roles of miRNAs in patients with cancer.

MicroRNA Biomarkers in Neurodegenerative Diseases and Emerging Nano-Sensors Technology

MicroRNAs (miRNAs) are essential small RNA molecules (20–24 nt) that negatively regulate the expression of target genes at the post-transcriptional level. Due to their roles in a variety of biological processes, the aberrant expression profiles of miRNAs have been identified as biomarkers for many diseases, such as cancer, diabetes, cardiovascular disease and neurodegenerative diseases. In order to precisely, rapidly and economically monitor the expression of miRNAs, many cutting-edge nanotechnologies have been developed. One of the nanotechnologies, based on DNA encapsulated silver nanoclusters (DNA/AgNCs), has increasingly been adopted to create nanoscale bio-sensing systems due to its attractive optical properties, such as brightness, tuneable emission wavelengths and photostability. Using the DNA/AgNCs sensor methods, the presence of miRNAs can be detected simply by monitoring the fluorescence alteration of DNA/AgNCs sensors. We introduce these DNA/ AgNCs sensor methods and discuss their possible applications for detecting miRNA biomarkers in neurodegenerative diseases.

Two cases of buried bumper syndrome after percutaneous endoscopic gastrostomy / 대한내과학회지

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support in patients who require prolonged tube feeding. However, numerous complications have been reported since its introduction. Buried bumper syndrome is an uncommon, but well-documented, complication of PEG placement. The condition often results from excessive pressure exerted on the gastric mucosa by the tight anchorage between the internal and external bumpers. This leads to mucosal erosion and embedding of the internal bumper in the gastric wall, which obstructs feeding. We report two cases of buried bumper syndrome: one was corrected using the push technique and the other was removed surgically.

A Case of Splenic Infarction Complicating Lymphoma

Splenic infarcts are comparatively less common lesions. Caused by the occlusion of the major splenic artery or any of its branches, they are almost always due to emboli that arise in the heart. The spleen, along with the kidneys and brain, ranks as one of the most frequent sites of localization of systemic emboli. Infarcts may be small or large, multiple or single, and sometimes involve the entire organ. Usually these infarcts are of the bland anemic type. Septic infarcts are found in vegetative endocarditis of the valves of the left side of the heart. Much less often, infarcts in the spleen are caused by local thromboses, especially in leukemia, myeloproliferative syndrome, sickle cell anemia, polyarteritis nodosa, Hodgkin's disease, and bacteremic diseases. We experienced a rather unusual splenic infarction due to lymphoma in a 80-year-old man.

A case of ectopic opening of the common bile duct (CBD) associated with hematemesis / 대한내과학회지

Ectopic opening of the common bile duct (CBD) in the duodenal bulb is not an incidental finding, but a pathologic condition that can be associated with clinical entities, such as recurrent duodenal ulcer, choledocholithiasis. or cholangitis. We report a case of ectopic CBD with hematemesis in a 61 year-old male patient. Esophagogastroduodenoscopy showed several active ulcers with a fresh blood clot at the duodenal bulb, which had a mucosal deformity and a small opening with suspicious drainage of bile, and the second part of the duodenum had no papilla-like structure. MRCP showed a trident-like pancreatobiliary tree. The biliary tree was visualized via a suspicious ectopic opening of the bile duct at the duodenal bulb. The distal CBD looked hook-shaped and had no filling defect. We report a unique case of ectopic opening of the CBD in the duodenal bulb, which presented as hematemesis.

Splenic Infarction, and Common Hepatic Artery and Pulmonary Emboli after Histoacryl(R)(N-butyl-2-cyanoacrylate) Injection for Control of Variceal Bleeding

Bleeding from esophageal and gastric varices is a life-threatening complication for patients with liver cirrhosis. Endoscopic injection of Histoacryl(R)(N-butyl-2-cyanoacrylate) has been reported to be an effective therapy for variceal bleeding; however, distal embolization of unwanted areas has been described in some cases with a fatal outcome. A change in the rationale of treatment of variceal bleeding in patients with liver cirrhosis was not advocated because of the infrequency of such cases. We report two cases of splenic infarction with celiac trunk and pulmonary emboli as serious complications of Histoacryl(R) injection.

Effect of Hemoperfusion on Treatment for Paraquat Poisoning / 대한내과학회지

Paraquat is a very potent herbicide which causes fatal toxicity when ingested, and there is no specific antidote against it. So it is known that most of the patients who ingested it die of pulmonary fibrosis. We used hemoperfusion(HP) for the treatment against paraquat poisoning from July 1993 till March 1994 and analysed the data using SPSS/PC ver4.0 for chi-square and t-test for mean +/- SD. The results were as follows: 1) A total of 36 paraquat poisoning patients(22 males and 14 females, mean age 48.8 years) visited our hospital, and i8 patients out of 36 received hemoperfusion(total 90 cycles); there were statistically significant differences in ages(41.4 +/- 15.6 year vs 56.2 +/- 15.0 year, p<0.05), but there was no significant difference in the amount of paraquat ingested(59.6 +/- 72.7ml vs 78.6 +/- 83.6ml, p=NS), gastric lavages(13/18 vs 16/18, p=NS), and use of Fuller's earth(8/18 vs 4/18, p=NS) between the patients who received HP and those who did not receive HP. 2) All the patients who did not receive HP died, but 9 patients out of 18 who received HP survived(p<0.005). There was no significant difference in ages(46.8 +/- 9.8 year vs 36.0 +/- 18.8 year, p=NS), amount of paraquat ingested(87.5 +/- 94.2 ml vs 34.8 +/- 36.4 ml, p=NS), gastric lavages(7/9 vs 6/9, p=NS), use of Fuller`s earth(5/9 vs 3/9, p=NS), and interval from the ingestion of paraquat to HP(52.449.9 hr vs 38339.7 hr, p=NS) between patients who died and those who survived, but SCr levels on arrival in expired patients were higher than those in surviving patients(5.0 +/- 3.5mg/dl vs 1.4 +/- 0.6mg/dl, p<0.05). Therefore, this suggests that hemoperfusion is very effective in the treatment of paraquat poisoning, and hemoperfusion is the most important factor in the prognosis of the patients.

A Study on Clinical Progress of the Metastatic Adenocarcinoma of Pleura / 결핵

BACKGROUND: We had undergone this study to investigate clinical progress of this disease and to decide the role of aggressive diagnostic approaches, the efficacy of treatments and prognoses. METHODS: A retrospective study was done on 113 patients who had been diagnosed to metastatic adenocarcinoma of pleura by pleural fluid cytology (106 cases) or pleural needle biopsy(22 cases), at Presbyterian Medical Center, from Jan. 1990 to Dec. 1994. RESULTS: 1) The patients were composed of 59 males(52.2%) and 54 females(47.8%), and the mean age distribution was 57.4 +/- 12.1 years. 2) The site of origin was lung cancer 46.9%(53/l 13), stomach cancer 20.4%(23/113), breast cancer 11.5%(13/113), and unknown primary site 6.2%(7/113 cases), as a whole. In male, lung cancer was 55.9%(33/59), stomach cancer was 28.8%(17/59), and in female, lung cancer was 37% (20/54), breast cancer was 24.1% (13/54) of cases. 3) The cardinal symptoms were dyspnea(69%), cough(61%), chest pain(50%), weight loss(50%), anorexia(49%), sputum(43%), malaise(30%). 4) The pleural fluid findings were exudative in 94.4%(102/108), serosanguinous or bloody in 36~53%, unilateral involvement in 74.3%(84/l 13) of cases, and lymphocyte predominance (71 +/- 27%) in differential count of WBC. 5) CEA levels in pleural fluid or plasma were over 10ng/ml in 60.6% (40/66), and ADA levels in pleural fluid were under 40U/L in 95% (57/60) of cases. 6) The patients were managed by various methods, but the efficacy of treatment was uncertain. 7) The mean survival time was 12.7 +/- 13.5 weeks. CONCLUSION: It seems to be no effective treatment methods yet and the prognosis was very poor in this disease, so the objectives of diagnostic approaches and treatment methods should be directed to early diagnosis, treatment and prevention of curable disease. And we must make our best endeavors to lengthen the survival time and improve the quality of patients' life.