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Utilization of Extracorporeal Membrane Oxygenation for Pulmonary Toxicity Caused by Inhaled Synthetic Cannabinoid. A Harbinger of Future Complications Associated with Inhaled Cannabinoid Products

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International Journal of Clinical Medicine 2020年第2期11卷 53-61页

作者： Robert March Paul Guentert Elizabeth Kloska-Kearney david kwak Cody Yerger Michael McBride J. R. Majewski Ross McCauley Jordan Hatch Jacob Speybroeck Allen Betts Mat Marsee Sufyan Zackariya Faisal Shariff Shivani Patel Ali Sualeh Anthony Thomas Edward Evans Donald Westerhausen Mark Walsh Saint Joseph Regional Medical Center Mishawaka IN USA Indiana University School of Medicine—South Bend South Bend IN USA Department of Pulmonary and Critical Care Medicine Methodist Hospital Indianapolis IN USA

There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted in an increase in a number of complications related not just to marijuana, but in particular, to SC. As a result, there have been recent increased reports of acute pulmonary injury related to inhaled SC products. We describe that rarely endotracheal intubation with mechanical ventilation has been required to treat the acute respiratory distress syndrome (ARDS) and the diffuse alveolar hemorrhage (DAH) associated with the acute toxicity of SC inhalation. We describe the second reported case of successful utilization of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in order to treat acute pulmonary toxicity caused by SC inhalation by a water pipe. While the exact pathophysiology of these interesting and recent pulmonary complications is unknown, the recent increase in exposure to SC via water pipe systems and vaping suggests that there will be many more cases of patients that will require ECMO as a form of life-saving therapy.

关键词： Synthetic Cannabinoid Extracorporeal Membrane Oxygenation Mechanical Ventilation Water Pipe Vaping Pulmonary Toxicity

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The changes of oligodendrocytes induced by anesthesia during brain development

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Neural Regeneration Research 2015年第9期10卷 1386-1387页

作者： Danye Jiang Sanghee Lim Minhye kwak Yun Kyoung Ryu C.david Mintz Department of Anesthesiology and Critical Care Medicine Johns Hopkins Medical Institutes

With the advent of modern techniques, drugs, and monitoring, general anesthesia has come to be considered an unlikely cause of harm, particularly for healthy patients. While this is largely true, newly emerging clinical and laboratory studies have sug- gested that exposure to anesthetic agents during early childhood may have long-lasting adverse effects on cognitive function. This concern has been the focus of intense study in the field of anesthesia research. A recent high-profile review by Rappaport et al. （2015） concluded that while many questions remain un- answered, there is strong evidence from laboratory studies that commonly used anesthetics interfere with brain development and that clinical studies suggest a correlation between early childhood exposure to these agents and subsequent effects on learning and cognition. The issue is of sufficient public health importance that a public-private partnership known as Smar- Tots （Strategies for Mitigating Anesthesia-Related Neurotoxicity in Tots） was developed by the FDA to study pediatric anesthetic neurotoxicity. The mechanism of injury underlying this phe- nomenon has yet to be fully elucidated, and there is evidence to suggest that anesthetics may have direct cytotoxic effects on neurons leading to cell death or suppressed neurogenesis （Strat- mann et al., 2010） and that they may interfere with key pro- cesses in neuronal growth and development that underlie brain circuit development （Wagner et al., 2014）.

关键词： The changes of oligodendrocytes induced by anesthesia during brain development

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RANKL-responsive epigenetic mechanism reprograms macrophages into bone-resorbing osteoclasts

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Cellular & Molecular Immunology 2023年第1期20卷 94-109页

作者： Seyeon Bae Kibyeong Kim Keunsoo Kang Haemin Kim Minjoon Lee Brian Oh Kaichi Kaneko Sungkook Ma Jae Hoon Choi Hojoong kwak Eun Young Lee Sung Ho Park Kyung-Hyun Park-Min Arthritis and Tissue Degeneration Program David Z.Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNY10021USA Department of Medicine Weill Cornell Medical CollegeNew YorkNY10065USA Department of Biological Science Ulsan National Institute of Science&Technology(UNIST)Ulsan44919Republic of Korea Department of Life Science College of Natural SciencesResearch Institute for Natural SciencesHanyang UniversitySeoulKorea Department of Microbiology Dankook UniversityCheonan3116Republic of Korea Department of Molecular Biology and Genetics Cornell UniversityIthacaUSA Division of Rheumatology Department of Internal MedicineSeoul National University College of MedicineSeoulKorea BCMB Allied Program Weill Cornell Graduate School of Medical SciencesNew YorkNY10021USA

Monocyte/macrophage lineage cells are highly plastic and can differentiate into various cells under different environmental stimuli. Bone-resorbing osteoclasts are derived from the monocyte/macrophage lineage in response to receptor activator of NF-κB ligand (RANKL). However, the epigenetic signature contributing to the fate commitment of monocyte/macrophage lineage differentiation into human osteoclasts is largely unknown. In this study, we identified RANKL-responsive human osteoclast-specific superenhancers (SEs) and SE-associated enhancer RNAs (SE-eRNAs) by integrating data obtained from ChIP-seq, ATAC-seq, nuclear RNA-seq and PRO-seq analyses. RANKL induced the formation of 200 SEs, which are large clusters of enhancers, while suppressing 148 SEs in macrophages. RANKL-responsive SEs were strongly correlated with genes in the osteoclastogenic program and were selectively increased in human osteoclasts but marginally presented in osteoblasts, CD4+ T cells, and CD34+ cells. In addition to the major transcription factors identified in osteoclasts, we found that BATF binding motifs were highly enriched in RANKL-responsive SEs. The depletion of BATF1/3 inhibited RANKL-induced osteoclast differentiation. Furthermore, we found increased chromatin accessibility in SE regions, where RNA polymerase II was significantly recruited to induce the extragenic transcription of SE-eRNAs, in human osteoclasts. Knocking down SE-eRNAs in the vicinity of the NFATc1 gene diminished the expression of NFATc1, a major regulator of osteoclasts, and osteoclast differentiation. Inhibiting BET proteins suppressed the formation of some RANKL-responsive SEs and NFATc1-associated SEs, and the expression of SE-eRNA:NFATc1. Moreover, SE-eRNA:NFATc1 was highly expressed in the synovial macrophages of rheumatoid arthritis patients exhibiting high-osteoclastogenic potential. Our genome-wide analysis revealed RANKL-inducible SEs and SE-eRNAs as osteoclast-specific signatures, which may contribute to t

关键词： Osteoclasts super-enhancers enhancer RNAs Rheumatoid arthritis

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经食管超声辅助双心室支持患者低氧血症的处理

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麻醉与镇痛 2013年第5期9卷 90-92页

作者： Jenny kwak, MD Douglas C. Shook, MD Andrew Locke, BS, RDCS david A. Silver, MD 吴镜湘(译) 徐关英(校) Department of Anesthesiology Perioperative and Pain Medicine Brigham and Women's Hospital Harvard Medical School Boston Massachusetts 不详

方法本病例报道已获得患街的书面知情同意。一例41岁男性病毒性心肌炎患者，因心源性休克药物治疗难以控制，放置了TandemHeart（CardiacAssit公司，Pittsburgh，PA）经皮左心辅助装置（1eftventricularassistdevice，LVAD），几天后又... 详细信息

方法本病例报道已获得患街的书面知情同意。一例41岁男性病毒性心肌炎患者，因心源性休克药物治疗难以控制，放置了TandemHeart（CardiacAssit公司，Pittsburgh，PA）经皮左心辅助装置（1eftventricularassistdevice，LVAD），几天后又放置了另一个TandemHeart有心辅助装置（fightventricularassistdevice，RVAD）.

关键词：经食管超声低氧血症患者双心室左心辅助装置病毒性心肌炎心源性休克病例报道

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亦敌亦友：管理互补企业的艺术

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工程经济 2006年第12期22卷 11-11页

作者： Mary kwak david B．Yoffie

商场如战场，“知己知彼，百战百胜”一直是商场竞争中的至高法则。如今，“知彼”的含义又有了进一步的延伸，它不仅包括了解你的竞争对手，还包括了解供应链上的各个合作伙伴，如供应商、分销商和客户，甚至还包括了解与你并没有业务... 详细信息

商场如战场，“知己知彼，百战百胜”一直是商场竞争中的至高法则。如今，“知彼”的含义又有了进一步的延伸，它不仅包括了解你的竞争对手，还包括了解供应链上的各个合作伙伴，如供应商、分销商和客户，甚至还包括了解与你并没有业务往来的互补企业（complementoro英特尔和微软就是一对著名的互补企业。它们相互之间没有买卖关系，但它们却同呼吸、共命运。

关键词：企业艺术管理商场竞争知己知彼竞争对手合作伙伴业务往来

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