BackgroundAlthough the utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO. The aim of this study was to investigate the changes in utilization and survival rate in patients supported with ECMO for severe respiratory failure in Korea.MethodsThis was a multicenter study on consecutive patients who underwent ECMO across 16 hospitals in Korea. The records of all patients who required ECMO for acute respiratory failure between 2012 and 2015 were retrospectively reviewed, and the utilization of ECMO was analyzed over time.ResultsDuring the study period, 5552 patients received ECMO in Korea as a whole, and a total of 2472 patients received ECMO at the participating 16 hospitals. We analyzed 487 (19.7%) patients who received ECMO for respiratory failure. The number of ECMO procedures provided for respiratory failure increased from 104 to 153 during the study period. The in-hospital survival rate increased from 30.8% to 35.9%. The use of prone positioning increased from 6.8% to 49.0% (p < 0.001), and the use of neuromuscular blockers also increased from 28.2% to 58.2% (p < 0.001). Multiple regression analysis showed that old age (OR 1.038 (95% CI 1.022, 1.054)), use of corticosteroid (OR 2.251 (95% CI 1.153, 4.397)), continuous renal replacement therapy (OR 2.196 (95% CI 1.135, 4.247)), driving pressure (OR 1.072 (95% CI 1.031, 1.114)), and prolonged ECMO duration (OR 1.020 (95% CI 1.003, 1.038)) were associated with increased odds of mortality.ConclusionsUtilization of ECMO and survival rates of patients who received ECMO for respiratory failure increased over time in Korea. The use of pre-ECMO prone positioning and neuromuscular blockers also increased during the same period.

Malignant cells are subjected to high levels of oxidative stress that arise from the increased production of reactive oxygen species (ROS) due to their altered metabolism. They activate antioxidant mechanisms to relieve the oxidative stress, and thereby acquire resistance to chemotherapeutic agents. In the present study, we found that PGC1α, a key molecule that both increases mitochondrial biogenesis and activates antioxidant enzymes, enhances chemoresistance in response to ROS generated by exposure of cells to ovarian sphere-forming culture conditions. Cells in the cultured spheres exhibited stem cell-like characteristics, and maintained higher ROS levels than their parent cells. Intriguingly, scavenging ROS diminished the aldehyde dehydrogenase (ALDH)-positive cell population, and inhibited proliferation of the spheres. ROS production triggered PGC1α expression, which in turn caused changes to mitochondrial biogenesis and activity within the spheres. The drug-resistant phenotype was observed in both spheres and PGC1α-overexpressing parent cells, and conversely, PGC1α knockdown sensitized the spheres to cisplatin treatment. Similarly, floating malignant cells derived from patient ascitic fluid included an ALDH-positive population and exhibited the tendency of a positive correlation between expressions of multidrug resistance protein 1 (MDR1) and PGC1α. The present study suggests that ROS-induced PGC1α mediates chemoresistance, and represents a novel therapeutic target to overcome chemoresistance in ovarian cancer.

This study examines the environmental impacts of roundtrip car sharing services by investigating transportation behavior. Car sharing should contribute to reduced greenhouse gas GHG emissions; however, such schemes include both positive and negative environmental effects, including: (1) reduced CO 2 e (carbon dioxide equivalent) from substituting private vehicle use for more fuel-efficient car sharing vehicles, (2) increased CO 2 e as car-less individuals switch from public transit to car sharing vehicles and (3) reduced CO 2 e due to fewer vehicles. This study examines the impacts of this modal shift on greenhouse gas (GHG) emissions using three types of models: a mixed logit model to analyze car sharing service preferences; a binary logit model to analyze whether individuals are willing to forgo vehicle ownership or planned purchases to use car sharing services; and a linear regression to determine how much private vehicle or public transportation use would be replaced by car sharing and the resulting effects on mobility. Total emissions from the current car sharing market equal 1,025,589.36 t CO 2 e/year. However, an increase in electric vehicle (EV) charging stations to 50% of the number of gasoline-fuel stations would increase the probability of electric car sharing vehicle use, thereby reducing emissions by 655,773 t CO 2 e. This study shows that forgoing vehicle purchases does not offset the increased GHG emissions caused by the shift from public transportation or private vehicle use to car sharing.

No abstract

In order to investigate the chemical characteristics of atmospheric aerosol measured during a severe winter haze event, 12-hr PM 2.5 (particulate matter with an aerodynamic diameter 2.5 m) samples were collected at an urban site in Ulaanbaatar, Mongolia, from January 9 to February 17, 2008. On average, 12-hr PM 2.5 mass concentration was 105.1 AE 34.9 g/m 3 . Low PM 2.5 mass concentrations were measured when low pressure developed over central Mongolia. The 12-hr average organic mass by carbon (OMC) varied from 6.4 to 132.3 g/m 3 , with a mean of 54.9 AE 25.4 g/m 3 , whereas elemental carbon (EC) concentration ranged from 0.1 to 3.6 gC/m 3 , with a mean of 1.5 AE 0.8 gC/m 3 . Ammonium sulfate was found to be the most abundant water-soluble ionic component in Ulaanbaatar during the sampling period, with an average concentration of 11.3 AE 5.0 g/m 3 . In order to characterize the effect of air mass pathway on fine particulate matter characteristics, 5-day back-trajectory analysis was conducted, using the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model. The haze level was classified into three categories, based on the 5-day air mass back trajectories, as Stagnant (ST), Continental (CT), and Low Pressure (LP) cases. PM 2.5 mass concentration during the Stagnant condition was approximately 2.5 times higher than that during the Low Pressure condition, mainly due to increased pollutant concentration of OMC and secondary ammonium sulfate.Implications: Mongolia is experiencing rapid rates of urbanization similar to other Asian countries, resulting in air pollution problems by the growing number of automobiles and industrialization. Ulaanbaatar, capital of Mongolia, is inherently vulnerable to air pollution because of its emission sources, topography, and meteorological characteristics. Very limited measurements on chemical characteristics of particulate matter have been carried out in Ulaanbaatar, Mongolia.

BackgroundWith improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR).MethodsBetween March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients’ medical records.ResultsThe return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis.ConclusionThe survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

Abstract. As a part of the IGAC (International Global Atmospheric Chemistry) Mega-cities program, aerosol physical and optical properties were continuously measured from March 2007 to March 2008 at an urban site (37.57 • N, 126.94 • E) in Seoul, Korea. Spectral optical properties of long-range transported Asian dust and pollution aerosols have been investigated based on the year long measurement data. Optically measured black carbon/thermally measured elemental carbon (BC/EC) ratio showed clear monthly variation with high values in summer and low values in winter mainly due to the enhancement of light attenuation by the internal mixing of EC. Novel approach has been suggested to retrieve the spectral light absorption coefficient (b abs ) from Aethalometer raw data by using BC/EC ratio. Mass absorption efficiency, σ abs (= b abs /EC) at 550 nm was determined to be 9.0±1.3, 8.9±1.5, 9.5±2.0, and 10.3±1.7 m 2 g −1 in spring, summer, fall, and winter, respectively with an annual mean of 9.4±1.8 m 2 g −1 . Threshold values to classify severe haze events were suggested in this study. Increasing trend of aerosol single scattering albedo (SSA) with wavelength was observed during Asian dust events while little spectral dependence of SSA was observed during long-range transport pollution (LTP) events. Satellite aerosol optical thickness (AOT) and Hysplit air mass backward trajectory analyses as well as chemical analysis were performed to characterize the dependence of spectral optical properties on aerosol type. Results from this study can provide useful information for studies on regional air quality and aerosol's effects on climate change.

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.