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Long-term Outcome of Fontan-Associated Protein-Losing Enteropathy: Treatment Modality and Predictive Factor of Mortality

  • Ja-Kyoung Yoon;Gi Beom Kim;Mi Kyoung Song;Sang Yun Lee;Seong Ho Kim;So Ick Jang;Woong Han Kim;Chang-Ha Lee;Kyung Jin Ahn;Eun Jung Bae
    • Korean Circulation Journal
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    • v.52 no.8
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    • pp.606-620
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    • 2022
  • Background and Objectives: Protein-losing enteropathy (PLE) is a devastating complication after the Fontan operation. This study aimed to investigate the clinical characteristics, treatment response, and outcomes of Fontan-associated PLE. Methods: We reviewed the medical records of 38 patients with Fontan-associated PLE from 1992 to 2018 in 2 institutions in Korea. Results: PLE occurred in 4.6% of the total 832 patients after the Fontan operation. After a mean period of 7.7 years after Fontan operation, PLE was diagnosed at a mean age of 11.6 years. The mean follow-up period was 8.9 years. The survival rates were 81.6% at 5 years and 76.5% at 10 years. In the multivariate analysis, New York Heart Association Functional classification III or IV (p=0.002), low aortic oxygen saturation (<90%) (p=0.003), and ventricular dysfunction (p=0.032) at the time of PLE diagnosis were found as predictors of mortality. PLE was resolved in 10 of the 38 patients after treatment. Among medical managements, an initial heparin response was associated with survival (p=0.043). Heparin treatment resulted in resolution in 4 patients. We found no evidence on pulmonary vasodilator therapy alone. PLE was also resolved after surgical Fontan fenestration (2/6), aortopulmonary collateral ligation (1/1), and transplantation (1/1). Conclusions: The survival rate of patients with Fontan-associated PLE has improved with the advancement of conservative care. Although there is no definitive method, some treatments led to the resolution of PLE in one-fourth of the patients. Further investigations are needed to develop the best prevention and therapeutic strategies for PLE.

Diesel Exhaust Particles Impair Therapeutic Effect of Human Wharton's Jelly-Derived Mesenchymal Stem Cells against Experimental Colitis through ROS/ERK/cFos Signaling Pathway

  • Hyun Sung Park;Mi-Kyung Oh;Joong Won Lee;Dong-Hoon Chae;Hansol Joo;Ji Yeon Kang;Hye Bin An;Aaron Yu;Jae Han Park;Hee Min Yoo;Hyun Jun Jung;Uimook Choi;Ji-Won Jung;In-Sook Kim;Il-Hoan Oh;Kyung-Rok Yu
    • International Journal of Stem Cells
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    • v.15 no.2
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    • pp.203-216
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    • 2022
  • Background and Objectives: Epidemiological investigations have shown positive correlations between increased diesel exhaust particles (DEP) in ambient air and adverse health outcomes. DEP are the major constituent of particulate atmospheric pollution and have been shown to induce proinflammatory responses both in the lung and systemically. Here, we report the effects of DEP exposure on the properties of human Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs), including stemness, regeneration, and immunomodulation. Methods and Results: Non-apoptotic concentrations of DEP (10 ㎍/ml) inhibited the migration and osteogenic differentiation capacity of WJ-MSCs. Gene expression profiling showed that DEP increased intracellular reactive oxygen species (ROS) and expression of pro-inflammatory and metabolic-process-related genes including cFos. Furthermore, WJ-MSCs cultured with DEP showed impaired suppression of T cell proliferation that was reversed by inhibition of ROS or knockdown of cFos. ERK inhibition assay revealed that DEP-induced ROS regulated cFos through activation of ERK but not NF-κB signaling. Overall, low concentrations of DEP (10 ㎍/ml) significantly suppressed the stemness and immunomodulatory properties of WJ-MSCs through ROS/ERK/cFos signaling pathways. Furthermore, WJ-MSCs cultured with DEP impaired the therapeutic effect of WJ-MSCs in experimental colitis mice, but was partly reversed by inhibition of ROS. Conclusions: Taken together, these results indicate that exposure to DEP enhances the expression of pro-inflammatory cytokines and immune responses through a mechanism involving the ROS/ERK/cFos pathway in WJ-MSCs, and that DEP-induced ROS damage impairs the therapeutic effect of WJ-MSCs in colitis. Our results suggest that modulation of ROS/ERK/cFos signaling pathways in WJ-MSCs might be a novel therapeutic strategy for DEP-induced diseases.

Evaluation of Field Applicability of Calcium Polysulfide for Cadmium and Zinc Immobilization in Groundwater and Its Impact on Microbial Ecology (환원제를 이용한 지하수 내 고농도 카드뮴 및 아연 고정화 기술 현장 적용성 평가 및 미생물 생태 변화 모니터링)

  • Sang Hun An;Dong-Hun Kim;Sung Pil Hyun;Soo Min Song;Hee Sun Moon;Byung Yong Yoon;Yong Hoon Cha;Kyoungphile Nam
    • Journal of Soil and Groundwater Environment
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    • v.29 no.5
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    • pp.14-26
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    • 2024
  • This study investigated the effectiveness of calcium polysulfide (CPS; CaSx) injection for the in-situ immobilization of cadmium and zinc-contaminated groundwater. The research focused on the impact of CPS injection on groundwater quality parameters, such as dissolved oxygen (DO), oxidation-reduction potential (ORP), and pH, as well as heavy metal precipitate formation and aquifer's microbial community dynamics on a field scale. The results demonstrated that the injected CPS formed a reactive zone, effectively reducing cadmium and zinc concentrations for a limited period. However, contaminant rebound occurred over time, necessitating repeated CPS injections. A single injection of CPS achieved a removal efficiency of 70~99%, lasting approximately 20 days. In contrast, repeated injections sustained the removal effects up to 37 days. Chemical analyses confirmed the precipitation of cadmium and zinc sulfide (CdS and ZnS), which remained stable in the aquifer even 86 days post-injection. Elemental sulfur (S) was detected in a significant quantity, contributing to the observed low DO levels. Microbial community exhibited a shift from an initial prevalence of sulfur-oxidizing and iron-oxidizing bacteria to a later dominance of sulfate-reducing bacteria following the cessation of high DO recycled water inflow, potentially enhancing the formation of CdS and ZnS.

A Study on Optimal Packing Volume of Media in Swirl Flow Biological Fluidized Bed (선회류 생물학적 유동상의 최적 메디아 충전량에 관한 연구)

  • Choi, Doo-Hyoung;Kim, Hwan-Gi
    • Journal of Korean Society of Environmental Engineers
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    • v.22 no.2
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    • pp.331-340
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    • 2000
  • The existing two-phase biological fluidized bed has some problems such as limit of oxygen transfer and blockade of fluidized distributor. In this study, three-phase swirl flow biological fluidized bed has designed to solve the problems and to investigate its running characteristics. TOC of influent synthetic wastewater was approximately $70mg/{\ell}$. HRT of reactor was 1.6 hours. Mean particle size of sand, as packing media, was 0.397mm and packing volume was varied from $200m{\ell}/{\ell}$ to $600m{\ell}/{\ell}$ by stages in the bed. The amount of biomass and effluent water quality was throughly investigated in the bed. Showing experiment results from the above conditions, it was possible to solve the problems of existing fluidized bed and to keep DO of $3mg/{\ell}$ or more. And it was also TOC removal rate of 91 to 94 %, MLVSS of 2,360 to $3,860mg/{\ell}$, MLVSS per g-media of 8.4 to 17.3 mg/g, F/M ratio of 0.59 to $1.04kg-TOC/kg-MLVSS{\cdot}day$, biofilm thickness of $35{\sim}71{\mu}m$ and sludge productivity of 1.03 to $2.35kg-SS/m^3{\cdot}day$. Optimal conditions in this experimental were as follows.; those were biofilm thickness of approximately $54{\mu}m$. MLVSS per g-media of 13 mg and media packing volume of 350 to $400m{\ell}/{\ell}$ when F/M ratio was low, treatment efficiency was high and sludge productivity was low. Showing the media with optics microscope in this optimal condition, attached microbes such as Epistylis sp. were observed. From SEM photographs, it showed that Coccus adhere to and grow on the media surface.

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Effect of Light-Induced ROS Generation Unit on Inactivation of Foodborne Pathogenic Bacteria in Water (광유도 ROS 발생장치의 세척용수 중 식중독 세균에 대한 불활성화 효과)

  • Choi, Jaehyuk;Kim, Dawoon;Jung, Kyu-Seok;Roh, Eunjung;Ryu, Kyoung-Yul;Ryu, Jae-Gee
    • Journal of Food Hygiene and Safety
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    • v.34 no.6
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    • pp.583-590
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    • 2019
  • As the consumption of fresh fruits and vegetables increases, food poisoning caused by foodborne pathogen contamination is not decreasing. To prevent the contamination of produce, a quick and easy, low-cost, environmentally-safe disinfection method that does not affect produce freshness or quality is needed. This study demonstrates a new-concept, circulating-water disinfection system that purifies water by using newly developed 'LED-PS (photosensitizer)-induced ROS generation unit'. Using various types of LED-PS induced ROS generation units, we investigated the conditions for reducing the density of various pathogenic bacteria by more than 3 log CFU / mL in 1 hour. The major operational factors affecting the density reduction of the LED-PS-induced ROS generation unit were analyzed. Depending on bacteria species, the density reduction rate was varied. The effect of the units on reducing the density of Bacillus cereus and Pectobacterium carotovorum subsp. carotovorum was high, but the effect on foodborne bacteria such as Escherichia coli was relatively low. In this circulating water disinfection system, the density reduction effect tended to increase as the flow rate increased and the initial bacterial density decreased. As the amount of PS absorbed beads increased, the density reduction effect increased exponentially in some bacteria. Model 3280, a double cylindrical unit connecting two single cylindrical units, could completely sterilize more than 3 log CFU/mL of B. cereus and P. carotovorum subsp. carotovorum in 30 minutes of LED irradiation.

The Comparison of Susceptibility Changes in 1.5T and3.0T MRIs due to TE Change in Functional MRI (뇌 기능영상에서의 TE값의 변화에 따른 1.5T와 3.0T MRI의 자화율 변화 비교)

  • Kim, Tae;Choe, Bo-Young;Kim, Euy-Neyng;Suh, Tae-Suk;Lee, Heung-Kyu;Shinn, Kyung-Sub
    • Investigative Magnetic Resonance Imaging
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    • v.3 no.2
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    • pp.154-158
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    • 1999
  • Purpose : The purpose of this study was to find the optimum TE value for enhancing $T_2^{*}$ weighting effect and minimizing the SNR degradation and to compare the BOLD effects according to the changes of TE in 1.5T and 3.0T MRI systems. Materials and Methods : Healthy normal volunteers (eight males and two females with 24-38 years old) participated in this study. Each volunteer was asked to perform a simple finger-tapping task (sequential opposition of thumb to each of the other four fingers) with right hand with a mean frequency of about 2Hz. The stimulus was initially off for 3 images and was then alternatively switched on and off for 2 cycles of 6 images. Images were acquired on the 1.5T and 3.0T MRI with the FLASH (fast low angle shot) pulse sequence (TR : 100ms, FA : $20^{\circ}$, FOV : 230mm) that was used with 26, 36, 46, 56, 66, 76ms of TE times in 1.5T and 16, 26, 36, 46, 56, 66ms of TE in 3.0T MRI system. After the completion of scan, MR images were transferred into a PC and processed with a home-made analysis program based on the correlation coefficient method with the threshold value of 0.45. To search for the optimum TE value in fMRI, the difference between the activation and the rest by the susceptibility change for each TE was used in 1.5T and 3.0T respectively. In addition, the functional $T_2^{*}$ map was calculated to quantify susceptibility change. Results : The calculated optimum TE for fMRI was $61.89{\pm}2.68$ at 1.5T and $47.64{\pm}13.34$ at 3.0T. The maximum percentage of signal intensity change due to the susceptibility effect inactivation region was 3.36% at TE 66ms in 1.5T 10.05% at TE 46ms in 3.0T, respectively. The signal intensity change of 3.0T was about 3 times bigger than of 1.5T. The calculated optimum TE value was consistent with TE values which were obtained from the maximum signal change for each TE. Conclusion : In this study, the 3.0T MRI was clearly more sensitive, about three times bigger than the 1.5T in detecting the susceptibility due to the deoxyhemoglobin level change in the functional MR imaging. So the 3.0T fMRI I ore useful than 1.5T.

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A Study on the Geochemical Clogging for the Assessment of the Hydrological Safety of the Underground Oil Storage Carvern (지하유류비축기지 수리안정성 평가를 위한 광물학적 클로깅 가능성 연구)

  • Kim, Geon-Young;Bae, Dae-Seok;Choi, Byeong-Young;Oh, Se-Joong;Koh, Yong-Hwon
    • Journal of the Mineralogical Society of Korea
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    • v.21 no.2
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    • pp.139-159
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    • 2008
  • Geochemical analysis of the various kinds of water including observation borehole groundwater was carried out for the assessment of the hydrological safety of the underground oil storage cavern and the potentiality of mineralogical and microbiological clogging was estimated. Most of water samples belonged to $Ca-HCO_3$ and $Ca-HCO_3-SO_4$ types. There was no distinct chemical difference in the various kinds of water. All kinds of water are undersaturated with the calcite which is the major clogging mineral. Most water samples have low Fe and Mn concentrations. However, they are saturated or oversaturated with the iron-oxide/hydroxide minerals and have high dissolved oxygen contents which suggests the possibility of clogging by the iron-oxide/hydroxide minerals as a long-term aspect. Several water samples from the ground observation borehole also show the high saturation indices far the clay minerals, which can fill up the fractures, indicating the possibility of clogging by the clay minerals. Statistical analysis shows the degree of mineral precipitation or dissolution is mainly controlled by pH, Eh and DO of water samples. According to the microbial analysis, the aerobic microbes and slime forming bacteria are dominant in most water samples and anaerobic microbes including sulfate reducing bacteria are very low or not detected. Although the slime forming bacteria which are known as a main microbial cause of the clogging is lower than $10^5\;CFUs/mL$ in all water samples, because the slime forming bacteria are dominant microbe in several observation boreholes, the clogging can be caused by it as a long-term aspect. In addition, the possibility of clogging can be increased if the microbial effect is combined with the mineralogical effect such as iron oxide/hydroxide minerals for the possibility of clogging. Therefore, the systematic and long-term program for the assessment of clogging is required for the safe operation of underground oil storage cavern.

Effect of Influent C/N Ratio and DO on Denitrification of Nitrate Polluted Groundwater in a Biofilter Process (Biofilter 공정에서 유입 C/N비와 DO가 지하수의 질산성 질소제거에 미치는 영향)

  • Lee, Moo-Jae;Park, Sang-Min;Park, Noh-Back;Jun, Hang-Bae;Kim, Kong-Soo
    • Journal of Korean Society of Environmental Engineers
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    • v.28 no.4
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    • pp.355-361
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    • 2006
  • In this study, effects of influent C/N(COD/Nitrate) ratio and dissolved oxygen(DO) concentration on biological nitrate removal from groundwater were investigated in the fixed-type biofilter. Influent nitrate of 30 mg/L was removed completely by biological denitrification at the C/N ratio of 10 and 4.0, while residual nitrate of 5 mg/L occurred at the C/N ratio of 2.0, which resulted from deficiency of organic electron donor. Furthermore, nitrite was accumulated up to about 5 mg/L as the C/N ratio decreased to 2.0. Increase in DO concentration also inhibited denitrification activity at the relatively high C/N ratio of 5.0, which decreased the nitrate removal efficiency. Although the influent DO concentration was reduced as low as 0.3 mg/L using sodium sulfite($Na_2SO_3$), effluent nitrite was up to 3.6 mg/L. On the other hand, nitrate was completely removed without detection of nitrite at the DO concentration of 0.3 mg/L using nitrogen gas($N_2$) sparging. The organic matter for denitrification in biofilter were in the range from 3.0 to $3.5gSCOD/g{NO_3}^--N$, while utilized these values increased at the high DO concentration of 5.5 mg/L. In addition to the high DO concentration and the low influent C/N ratio, DO control by chemical such as sodium sulfite affected on biological denitrification, which resulted in the reduction of nitrate removal efficiency and nitrite build-up in a biofilter.

Vertical Profiles of Marine Environments and Micro-phytoplankton Community in the Continental Slope Area of the East China Sea in Early Summer 2009 (이른 여름 동중국해 대륙사면의 해양환경과 소형 식물플랑크톤 군집의 연직분포 특성)

  • Yoon, Yang Ho
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.16 no.3
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    • pp.151-162
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    • 2013
  • Studies of the distribution of micro-phytoplankton community and chlorophyll a concentration have focused on the vertical profiles of marine environmental factors such as water temperature, salinity, sigma-t, light intensity, and dissolved oxygen in the continental slope on the east parts of East China Sea in the early summer of 2009. Water temperature showed a gradual reduction according to the depth. While the salinity was low in the surface layer showing a mixed down to the relatively subsurface layer, it was increased with an increase in the depth at the middle and bottom layers showing a maximum value at 150~200 m followed by a decreasing aspect afterwards, although the change was not large. The change of sigma-t was governed by the water temperature, and gradually increased in the surface layer with an increase in the depth, showing a value higher than in the surface layer by about 3 $kg/m^3$ at the bottom layer. Although the intensity of light was exponential reduced in the surface layer, the compensation depth was located at the depth of about 80m. The vertical profiles of chlorophyll a concentration was governed by the intensity rather than the changes in water temperature or salinity, exhibiting a maximum value at the compensation depth corresponding to 1% in the surface light intensity. The micro-phytoplankton communities consisted of 56 genera 103 species showing a relatively variety, while the standing crop was also changed to 112.0~470.0 cells/L in the pelagic environment, showing a maximum chlorophyll a concentration. Although a variety of dominant species appear at low dominance without dominant species appearing with a right-wing point in the phytoplankton communities, the silicoflagellate, Otactis otonaris at the station A and the dominance of 26% due to Leptocylindrus mediterraneus at the station C have been judged to be unusual. For community analysis of infinitesimal creatures such as phytoplankton of oligotrophic waters through the present study, ecology studies through vertical sample collection agreeing with the results of continuous observation such as identification of vertical distribution in a marine environment or of maximum chlorophyll layers have been considered rather than a survey method with intervals of a given depth such as surface, subsurface, middle and bottom layers.

Effects of Nursery Environmental Factors on the Growth of Pacific Oyste, Crassostrea gigas (양식어장 환경요인이 참굴 (Crassostrea gigas)의 성장에 미치는 영향)

  • 배평암;한창희
    • Journal of Aquaculture
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    • v.11 no.3
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    • pp.391-400
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    • 1998
  • This study was performed to investigate the effects of environmental parameters on the growth of Pacific oyster, Crassostrea gigas at old suspended culturing grounds of Korsung Bay and newly deveoped bottom, culturing grounds of Haenam region located in southern coast of Korea. The Kosung Bay was semiclosed and water exchange occurred through the small mouth and the current speed was very slow as the value of below 0.5kn. Haenam was opened and littoral zone. Current speed of the surroundings of this Bay about to 5.0knand transparency was low with the mean depth of 1.2m by the resuspension of the sediments. Water temperature and salinity regimes were suitable for oysters at those sites, however the mean value of those parameters and seasonal fluctuations was high at Kosung. The mean concentration of dissolved oxygen in survey area was above $5.0mg/\ell$. In Kosung, however, it was decreasing in June and showed the minimum with the concentration of $4.0mg/\ell$ in August at the bottom layer and recovered in September. Eutrophication parameters such as COD were 1.44 mg/l at this location. This mean value was higher than that of the Haenam Bay's $0.96mg/\ell$. The men value of chlorophyll-$\alpha$ at Haenam was two times higher than the other sites. Growth of shell height and meat weight of oysters at Kosung Bay were higher and the fatness was lower compared to thost of Haenam. As a result, absolute growth of oysters was high at Kosung and allometric growth, such as fatness, was good at Haenam. Low water temperature and frequent exposure of oysters to the air during ebb tide may retard the shell growth. On the other hand, relatively high food availability was profitable for the fatness at haenam site.

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