No abstract

Objective: Gotjawal refers to a special geographical designation found in Jeju Province, Korea, where vegetation forms over a rocky area. Due to the important ecological value of Gotjawal, international concern about such areas is growing. However, only limited information is available regarding environmental contamination of Gotjawal. This study was conducted in order to investigate the levels of contamination and associated ecotoxicological effects of surface water bodies in Gotjawal.Methods: Surface water samples were collected at three sampling sites in two Gotjawal areas and were analyzed for several pharmaceuticals and pesticides in consideration of the potential sources of contamination. The ecotoxicity of the samples was measured using water fleas (Daphnia magna and Moina macrocopa) and zebrafish (Danio rerio). In addition, effects on the gene transcription of zebrafish were investigated following exposure to the samples. Results:Nine pharmaceuticals were detected in the samples, but none of the target pesticides were detected. Following acute exposure to two surface water samples, the survival of waterfleas was significantly reduced, but reproduction was not affected. In zebrafish, time-to-hatch was delayed and fry survival was decreased in some samples. On the other hand, at the transcriptional level, there were no genes significantly influenced by exposure to the samples. Conclusion:This is the first study investigating environmental contamination in Gotjawal areas and associated ecotoxicities. Further studies are warranted to identify the cause of acute Daphnia toxicity and to determine potential consequences of longer-term exposure in Gotjawal areas.

Rationale: Patients with cancer have elevated risk of both venous thromboembolism and bleeding compared with patients without cancer due to cancer- and patient-specific factors. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult because management of cancer-associated thrombosis requires anticoagulation despite its known increased risks for bleeding. The adjustment of blood transfusion or cessation of anticoagulants can be a challenge in surgical diagnosis or treatment of cancer patients with such an imbalanced coagulate status. Patient concerns: A 45-year-old woman with no underlying disease was suspected of ovarian cancer and was awaiting diagnostic laparoscopic exploration surgery. Diagnoses: While waiting for the surgery, the patient developed chest pain and underwent stent insertion under diagnosis of myocardial infarction. Two weeks later, endocarditis developed, and replacement of the aortic valve and mitral valve was planned. In addition, the patient developed multiple thromboembolisms and was administered anticoagulants to eliminate vegetation of valves and multiple thromboses. Her blood test showed anemia (7.4 g/dL) and severe thrombocytopenia (24 × 10 9 /L). Interventions: The patient underwent double valve replacement. Outcomes: A color change of the left lower extremity was noted 5 hours after double valve replacement, and angiography was performed. Thrombectomy was performed under diagnosis of thrombosis in the left iliac artery. One month later, the patient underwent laparoscopic exploration surgery as scheduled. Lessons: This case will help establish the criteria of blood coagulation for surgical treatment of cancer patients with imbalanced clotting and bleeding.