Sung Woon Chung

Establishment of Porphyromonas gingivalis heat-shock-protein-specific T-cell lines from atherosclerosis patients.

Human atherosclerotic plaques contain heat-shock proteins which may serve as potential targets of the immune response in atherosclerosis. Since periodontal infections are suggested as risk factors for the development of cardiovascular diseases, we undertook the present study to evaluate the T-cell immune responses specific to Porphyromonas gingivalis (P. gingivalis) heat-shock protein (hsp)60 in patients suffering from atherosclerosis. Anti-P. gingivalis hsp60 IgG antibody titers were elevated in all patients. We could establish P. gingivalis hsp-specific T-cell lines from the atheroma lesions and the peripheral blood. The T-cell lines were a mixture of CD4+ and CD8+ cells producing the cytokines characteristic of both Th1 and Th2 subsets. The present findings suggest that the T-cell immune response specific to P. gingivalis hsp60 may be involved in the immunopathologic process of atherosclerotic diseases.

Epitope Mapping of Porphyromonas gingivalis Heat-shock Protein and Human Heat-shock Protein in Human Atherosclerosis

To identify T- and/or cross-reactive B-cell epitopes of P. gingivalis and human heat-shock protein (HSP)60 in atherosclerosis patients, we synthesized 104 overlapping synthetic peptides spanning whole molecules of P. gingivalis HSP60 and human HSP60, respectively. T-cell epitopes of P. gingivalis HSP were identified with the use of previously established P. gingivalis HSP-reactive T-cell lines. B-cell epitopes of P. gingivalis HSP60 and human HSP60 were identified by the use of patients’ sera. Anti-P. gingivalis, anti-P. gingivalis HSP60, or anti-human HSP60 IgG antibody titers were higher in the atherosclerosis patients compared with the healthy subjects. Five immunodominant peptides of P. gingivalis HSP60, identified as T-cell epitopes, were also found to be B-cell epitopes. Moreover, 6 cross-reactive B-cell epitopes of human HSP60 were identified. It was concluded that P. gingivalis HSP60 might be involved in the immunoregulatory process of atherosclerosis, with common T- and/or B-cell epitope specificities and with cross-reactivity with human HSP60.

Endovascular Treatment of a Ruptured Internal Thoracic Artery Pseudoaneurysm Presenting as a Massive Hemothorax in a Patient with Type I Neurofibromatosis

We report a case of acute hemothorax caused by a left internal thoracic artery pseudoaneurysm rupture in a patient with neurofibromatosis type I, which was successfully treated with endovascular coil embolization.

Double Primary Aortoenteric Fistulae: A Case Report of Two Simultaneous Primary Aortoenteric Fistulae in One Patient

Aortoenteric fistula is a rare but potentially fatal condition causing massive gastrointestinal bleeding. In particular, double primary aortoenteric fistulae are vanishingly rare. We encountered a 75-year-old male patient suffering from abdominal pain, hematochezia, hematemesis, and hypotension. His computed tomography images showed abdominal aortic aneurysm and suspected aortoenteric fistulae. During surgery, we found two primary aortoenteric fistulae. The one fistula was detected between the abdominal aorta and the third portion of the duodenum, and the other fistula was detected between the abdominal aorta and the sigmoid colon. We conducted the closure of the fistulae, the exclusion of the aneurysm, and axillo-bifemoral bypass with a polytetrafluoroethylene graft. The patient was discharged with no complications on the 21st postoperative day.

Peptidoglycan Up-Regulates CXCL8 Expression via Multiple Pathways in Monocytes/Macrophages.

Peptidoglycan (PG), the gram positive bacterial pathogen-associated molecular patterns (PAMP), is detected in a high proportion in macrophage-rich atheromatous regions, and expression of chemokine CXCL8, which triggers monocyte arrest on early atherosclerotic endothelium, is elevated in monocytes/macrophages in human atherosclerotic lesion. The aim of this study was to investigate whether PG induced CXCL8 expression in the cell type and to determine cellular signaling pathways involved in that process. Exposure of THP-1 cell, human monocyte/macrophage cell line, to PG not only enhanced CXCL8 release but also profoundly induced il8 gene transcription. PG-induced release of CXCL8 and induction of il8 gene transcription were blocked by OxPAPC, an inhibitor of TLR-2/4 and TLR4, but not by polymyxin B, an inhibitor of LPS. PG-mediated CXCL8 release was significantly attenuated by inhibitors of PI3K-Akt-mTOR pathways. PKC inhibitors, MAPK inhibitors, and ROS quenchers also significantly attenuated expression of CXCL8. The present study proposes that PG contributes to inflammatory reaction and progression of atherosclerosis by inducing CXCL8 expression in monocytes/macrophages, and that TLR-2, PI3K-Akt-mTOR, PKC, ROS, and MAPK are actively involved in the process.

General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair.

Upper Limb Ischemia: Clinical Experiences of Acute and Chronic Upper Limb Ischemia in a Single Center.

Background Upper limb ischemia is less common than lower limb ischemia, and relatively few cases have been reported. This paper reviews the epidemiology, etiology, and clinical characteristics of upper limb ischemia and analyzes the factors affecting functional sequelae after treatment. Methods The records of 35 patients with acute and chronic upper limb ischemia who underwent treatment from January 2007 to December 2012 were retrospectively reviewed. Results The median age was 55.03 years, and the number of male patients was 24 (68.6%). The most common etiology was embolism of cardiac origin, followed by thrombosis with secondary trauma, and the brachial artery was the most common location for a lesion causing obstruction. Computed tomography angiography was the first-line diagnostic tool in our center. Twenty-eight operations were performed, and conservative therapy was implemented in seven cases. Five deaths (14.3%) occurred during follow-up. Twenty patients (57.1%) complained of functional sequelae after treatment. Functional sequelae were found to be more likely in patients with a longer duration of symptoms (odds ratio, 1.251; p=0.046) and higher lactate dehydrogenase (LDH) levels (odds ratio, 1.001; p=0.031). Conclusion An increased duration of symptoms and higher initial serum LDH levels were associated with the more frequent occurrence of functional sequelae. The prognosis of upper limb ischemia is associated with prompt and proper treatment and can also be predicted by initial serum LDH levels.

Is extracorporeal cardiopulmonary resuscitation practical in severe chest trauma? A systematic review in single center of developing country

BACKGROUND We report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma. METHODS From April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels after focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a Level I trauma center presenting with cardiac tamponade and tension hemothorax due to severe chest trauma. Patients were divided as follow: group A (n = 3), patients without cardiac arrest before entering the operating theatre; group B (n = 5), patients with cardiac arrest for whom ECPR was applied, and group C (n = 2), patients with cardiac arrest for whom ECPR was not applied. RESULTS All patients underwent exploratory thoracotomy or sternotomy. Injuries included cardiac chamber ruptures (n = 8), lesions in the internal mammary arteries (n = 1), and lesions of the bronchial arteries (n = 1). In group B, extracorporeal membrane oxygenation (ECMO) was initiated and circulation was restored promptly with adequate extracorporeal blood flow in all five cases. These patients were weaned off ECMO uneventfully after controlling the bleeding in the operating theatre. Mean ECMO time was 142 ± 48.2 minutes. Conversely, both patients in group C died, one due to low cardiac output on postoperative day 1, and the other due to multiple-organ failure on postoperative day 7. CONCLUSION ECPR may be an option to rescue and stabilize patients with cardiac arrest due to severe chest trauma. LEVELS OF EVIDENCE Therapeutic/Care Management, Level V.

The Factors Affecting Recurrence of Symptoms after Infrainguinal Arterial Endovascular Angioplasty

Background This study reports the result of endovascular treatment for arterial occlusive disease limited to femoropopliteal lesions, focusing on the recurrence of symptoms instead of patency. Methods This was a retrospective, single-center study. From April 2007 to November 2011, 48 limbs in 38 patients underwent endovascular stenting or balloon angioplasty to treat femoropopliteal arterial occlusive disease. The factors affecting the recurrence of symptoms were analyzed. Results The mean age of the patients was 69.60±7.62 years. Among the baseline characteristics of the patients, initial hyperlipidemia was the most important factor affecting the recurrence of symptoms (relative risk=5.810, p=0.031). The presence of a dorsal arch was also a significant factor (relative risk=0.675, p=0.047). Conclusion The major factors that affect the recurrence of symptoms after endovascular treatment for femoropopliteal arterial occlusive lesions are hyperlipidemia and the presence of a dorsal arch. Therefore, the usage of lipid-lowering agents after endovascular treatment and taking the presence of a dorsal arch into consideration are important elements of managing the recurrence of symptoms.

Should We Remove the Retrievable Cook Celect Inferior Vena Cava Filter? Eight Years of Experience at a Single Center

Background The inferior vena cava filter (IVCF) is very effective for preventing pulmonary embolism in patients who cannot undergo anticoagulation therapy. However, if a filter is placed in the body permanently, it may lead to other complications. Methods A retrospective study was performed of 159 patients who underwent retrievable Cook Celect IVCF implantation between January 2007 and April 2015 at a single center. Baseline characteristics, indications, and complications caused by the filter were investigated. Results The most common underlying disease of patients receiving the filter was cancer (24.3%). Venous thrombolysis or thrombectomy was the most common indication for IVCF insertion in this study (47.2%). The most common complication was inferior vena cava penetration, the risk of which increased the longer the filter remained in the body (p=0.032, Exp(B)=1.004). Conclusion If the patient is able to retry anticoagulation therapy and the filter is no longer needed, the filter should be removed, even if a long time has elapsed since implantation. If the filter cannot be removed, it is recommended that follow-up computed tomography be performed regularly to monitor the progress of venous thromboembolisms as well as any filter-related complications.