• Clinical and Experimental Pediatrics
• /
• v.53 no.2
• /
• pp.228-234
• /
• 2010

Purpose : Although intravenous immunoglobulin (IVIG) treatment is an effective first-line treatment for Kawasaki disease, 10-20% of the patients develop persistent fever or coronary artery complications. Medical records of Kawasaki disease patients were reviewed to assess the characteristic laboratory findings of IVIG nonresponsiveness. Methods : We reviewed the clinical records of 118 children with Kawasaki disease who were treated at the Chonnam National University Hospital from March 2003 to February 2008. The laboratory findings of the IVIG-responder group (n=110) and the IVIG-nonresponder group (n=8) were compared at admission day and at 48 hours and 14 days after IVIG administration. Results : At admission, the level of creatine kinase (CK) was lower (P =0.03) and that of total protein was higher (P <0.01) in the nonresponders than in the responders. At 48 hours after IVIG administration, the white blood cell (WBC) count (P =0.04) and neutrophil% (P <0.01) was higher in the nonresponders than in the responders. The neutrophil% (P <0.01) and CK (P =0.01) level at admission was lower than that at 48 hours after IVIG administration in the responders; this decrease was not as apparent in the nonresponders. Conclusion : IVIG nonresponders have lower CK and higher total protein levels at admission and higher WBC count and neutrophil% at 48 hours after IVIG administration. The decrease in the neutrophil% and CK level between at admission and at 48 hours after IVIG administration is remarkably higher in responders than in nonresponders.

• The Korean Journal of Nuclear Medicine
• /
• v.30 no.1
• /
• pp.95-103
• /
• 1996

Reverse redistribution(RRD) refers to a perfusion defect that develops or becomes more evident on rest imaging compared with the stress imaging. This phenomenon was not uncommonly noted on myocardial perfusion single photon emission computed tomography (SPECT). However, the clinical significance and pathophysiological mechanism of RRD were unclear. The aim of this study was to evaluate the incidence and clinical significance of RRD on either dipyridamole T1-201 or Tc-99m MIBI myocardial perfusion SPECT. RRD was defined as ${\geq}10%$ decrease in relative T1-201 and Tc-99m MIBI uptakes on rest images compared to the stress images or as an appearance of new perfusion defects on rest images. It was observed in both T1-201 (44/463, 9.5%) and Tc-99m MIBI (124/999, 12.4%) myocardial SPECTs similarly, with an overall incidence of 11.5%(168/1462). Many apparent)y unrelated disease groups showed the finding: post-revascularization(53.9%), coronary artery disease(24.6%), myocardial infarction(12.3%), and those with normal coro-nary arteries (9.2%). Clinical and angiographic characteristics of 65 consecutive patients who underwent coronary arteriography in 168 patients who had RRD on myocardial perfusion SPECT were reviewed. Tc-99m MIBI was used in 44 patients, and T1-201 was used in 21 patients. Of the 81 myocardial segments analyzed which showed RRD, 32 segments(39.5%) were in septum, 24(29.5%) in inferior wallL, 12(14.8%) in anterior wall, 7(8.7%) in apex and 6(7.4%) in lateral wall. There was no clear association between RRD and coronary arterial stenosis or Presence of collateral circulations. Ventriculographical wall motion was evaluated in 27 regions with RRD; it was normal in 12 regions, hypokinetic in 12 regions and dyskinetic in 3 regions. In 14 of 21 patients who showed RRD on T1-201 myocardial SPECT, T1-201 reinjection was performed immediately after the 3-4 hour redistribution studies. Ten of 14 (71.4%) showed enhanced T1-201 activity(${\geq}10%$ increased) after reinjection. We conclude that RRD is not related to mode of stress or radiopharmaceuticals. RRD might represent many inhomogeneous pathophysiological processes.

• Korean Journal of Clinical Pharmacy
• /
• v.27 no.1
• /
• pp.15-21
• /
• 2017

Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.

• Journal of Nutrition and Health
• /
• v.40 no.2
• /
• pp.162-171
• /
• 2007

Obesity is an independent risk factor fur coronary artery disease in the postmenopausal women, which may be mediated by alteration of blood lipid metabolism. We are aimed to evaluate the effects of low energy diet, restriction of high fat foods and exercise education on weight, fat mass and blood lipid profile. Fifteen postmenopausal obese women were studied. Subjects received detailed advice about how to achieve a reduction of weight by a low-energy diet (1,200kcal), restriction of high fat food and increased exercise in every 4 wks during 8 wk. To evaluate the effectiveness for education programs, dietary fat habit and daily nutrient intakes, exercise were tested before and after intervention. Anthropometry, computerized tomography, and blood lipid profile were assessed before and after intervention. According to the nutrition education, energy intake (from 1776.1 ${\pm}$ 28.2 kcal to 1268.7 ${\pm}$ 115.2 kcal, p < 0.001) and percent of energy from fat (21.9%, p < 0.01) were significantly decreased. However, the index of nutritional quality was over 1.0. On the contrary, exercise (from 341.3 ${\pm}$ 222.1 kcal to 569.4 ${\pm}$ 309.8 kcal, p < 0.05) was increased and dietary fat habit scores (from 30.8 ${\pm}$ 5.2 to 36.1 ${\pm}$ 3.0, p < 0.01) were improved. Also, body weight (4.2%, p < 0.001), BMI (4.5%, p < 0.001), body fat mass (3.4%, p < 0.05) and waist to hip ratio (1.1%, p < 0.05) were decreased. Among abdominal fat, visceral fat (26.1%, p < 0.05) and subcutaneous fat (14.8%, p < 0.01) were decreased. But there was no difference in visceral fat to subcutaneous fat ratio. We observed HDL-cholesterol increase (11.7%, p < 0.05), triglyceride reduction(14.8%, p < 0.05) and atherogenic index improvement (from 2.7 ${\pm}$ 0.7 to 2.3 ${\pm}$ 0.7, p < 0.05) However, there was no change in LDL-cholesterol and total cholesterol. Theses results showed that low energy diet, restriction of high fat foods and exercise education could result in reduction of body weight, fat mass, visceral and subcutaneous fat, and in improvement of blood lipid profile in the postmenopausal obese women.

• Journal of Chest Surgery
• /
• v.21 no.6
• /
• pp.1020-1029
• /
• 1988

The authors evaluated 153 patients who had undergone cardiac valve replacement between October 1979 and July 1988. The results are as follows: l. Out of 153 patients, there were 56 males and 97 females ranging from 15 to 62 years of age with a mean of 37 years. 2. Isolated mitral valve replacement took place in 82 patients, aortic valve replacement[AVR] in 16, double valve replacement[DVR] in 34, AVR combined with open mitral commissurotomy in 19, and tricuspid valve replacement[TVR] was done in 2 patients. 3. 153 patients had 187 prosthetic valves replaced with Ionescu-Shiley valves[16], Carpentier-Edwards[36], Bjork-Shiley[19], St. Jude Medical[108], and Duromedics[8]. 4. Our of 98 patients with atrial fibrillation[ 64% of a total 153 patients ] during the preoperative period, 22 patients recovered NSR[ 22/98, NSR recovery rate 22.4%] after valvular surgery and remaining 76 patients revealed persisting atrial fibrillation[76/153, 49.7% ]. 5. Preoperative episodes of systemic arterial embolization were attained in 9 patients[9/153, 6% ], and left atrial thrombi were confirmed in 22 patients intraoperatively[ 22/153, 14% ]. Of these, only one patient, however, demonstrated the correspondence of preoperative embolization and intraoperative existence of LA thrombi. 6. With mechanical prostheses, anticoagulant therapy was begun 48 hours after operation with sodium warfarin[2.5-5.0mg/day], maintaining the prothrombin time between 16 and 18 seconds or 30 to 50% of control values and continued for life. With tissue prostheses, sodium warfarin was continued for 3 to 6 months and converted into buffered ASA[ 325 mg/day ] for one year. 7. The mean follow-up for the survivors was 30.1 months, with a range from 3 months to 9 years. All suspected or confirmed thromboembolic episodes counted as events and occurred in 4 patients[ 1.04%/patient-year] with mechanical valve replacement. No persistent paralysis or death was noted. Late complications have not yet occurred in the patients with isolated MVR and AVR. 8. There were remarkable structural failures of tissue valves in 3 patients[ 1.9%/patient-year ], while no instance of failure of a mechanical valve. 9. There were 10 operative early deaths[10/153, 6.5%] and 5 late deaths[5/153, 3.3%]. Consequently, overall mortality was 9.8%[ 15/153] during follow-up period. 10. We currently favor using the St. Jude Medical valve in all patients requiring valve replacement except in those who can not take warfarin anticoagulation.

• The Korean Journal of Nuclear Medicine
• /
• v.35 no.3
• /
• pp.152-160
• /
• 2001

Purpose: We tried to establish the reproducibility of the measurement of maximal elastance (Emax) and to compare the degree of the reproducibility of two estimation methods: single pressure-volume loop method and parameter optimization method. Materials and methods: In 47 patients (42 males and 5 females, $53{\pm}10$ years old) with suspected coronary artery disease (election fraction; 22-68%), gated Tc-99m MIBI myocardial SPECT and arterial tonometry were acquired. In 11 patients among these 47 patients, gated SPECT and tonometry were performed twice consecutively with patients in situ. Emax and void volume (Vo) were estimated using single pressure-volume loop method of Lee and parameter optimization method based on linear approximation of Yoshizawa. Correlation between the consecutive measurements by each method and correlation between the two estimation methods were compared. Results: Reproducibility of Emax (r=0.96) and Vo (r=0.99) by single pressure-volume method was better than the reproducibility of Emax (r=0.89) and Vo (r=0.64) by parameter optimization method. Correlations of Emax and Vo were fair between the two methods. The correlation of Emax (r=0.77) was better than that of Vo (r=0.55). Conclusion: Reproducibility of Emax measurement by single pressure-volume loop method using gated myocardial SPECT and arterial tonometry was excellent. Reproducibility by parameter optimization method was also fair but was less than that achieved by single pressure-volume method.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.18 no.11
• /
• pp.1-6
• /
• 2017

Stents are widely used as the most common method of treating coronary artery disease with implants in the form of a metal mesh. The blood flow is normalized by inserting a stent into the narrowed or clogged areas of the human body. In this study, the mechanical characteristics of a stent are investigated according to the variations of its design parameters by the Taguchi method and finite element analysis. A stent model of the Palmaz-Schatz type was used for the analysis. In the analysis, an elasto-plastic material model was adopted for the stent and a hyper-elastic model was used for the balloon. The main interest of this study is to investigate the effects of the design parameters which reduce the possibility of restenosis by adjusting the recoil amount. A Taguchi orthogonal array was constructed on the model of the stent. The thickness and length and angle of the slot were selected as the design parameters. The amounts of radial recoil and longitudinal recoil were calculated by finite element analysis. The statistical analysis using the Taguchi method showed that optimizing the shape of the stent could reduce the possibility of restenosis. The optimized shape showed improvements of recoil in the radial and longitudinal directions of ~1% and ~0.1%, respectively, compared to the default model.

• Clinical and Experimental Pediatrics
• /
• v.52 no.2
• /
• pp.187-193
• /
• 2009

Purpose : Adiponectin is a molecule that plays an important role in the metabolic syndrome. In addition, its concentration is known to be decreased in obesity, type 2 diabetes, and coronary artery disease. Although a relationship between hypertension and serum adiponectin concentrations has been reported by several authors, such findings continue to be debated. We investigated whether hypoadiponectinemia is related to hypertension in adolescents and studied the associated genetic polymorphism. Methods : Forty hypertensive adolescents (Age 16-17 years old) and twenty normotensive matched subjects were included. Serum adipo-nectin, insulin, renin, aldosterone and angiotensin converting enzyme (ACE) levels were compared. Their carotid intima-media thickness (cIMT) and pulse wave velocity (PWV) were measured. Polymorphisms of the adiponectin I164T gene were investigated using polymerase chain reaction (PCR). Results : The hypertensive adolescents had significantly greater cIMT and PWV. In addition, the serum aldosterone, renin and insulin levels were significantly higher in the hypertensive group. The plasma concentrations of adiponectin did not differ significantly between the two groups. TC genotype was not found in our study subjects; they all had the TT genotype of the adiponectine gene. Conclusion : The results of our study showed that adiponectin levels were not significantly different in adolescents with hypertension. There was no distinctive genetic polymorphism observed in this group of patients. Further large scale studies are needed to clarify the association between genetic variations and adiponectin in hypertensive adolescents.

• Journal of Preventive Medicine and Public Health
• /
• v.40 no.1
• /
• pp.71-76
• /
• 2007

Objectives : This study was performed to investigate the distribution of apolipoproteins A-I and B among Korean employees and their partners. Methods : The study population consisted of 7,633 men and women (4,578 men and 3,054 women) residing in Seoul and Kyung-gee Do, with an average age of $43.5{\pm}8.3$ years. Blood samples were collected following at least 12 hours of fasting. Apolipoproteins A-I and B were measured using a Behring Nephelometer analyzer. The body mass index (BMI) for each participant was calculated as weight (kg) divided by height squared $(m^2)$. Information on health-related behaviors such as exercise, alcohol intake, and smoking habits was collected through self-administrated questionnaires. Results : The mean concentrations of Apo A-I were $132.6{\pm}22.3mg/dL$ and $142.9{\pm}24.8mg/dL$ in the men and women, respectively. The concentration of Apo A-I increased significantly across all age categories of men. The mean concentrations of Apo B were $101.7{\pm}23.2mg/dL$ and $87.8{\pm}23.5mg/dL$ in the men and women, respectively, and Apo B increased significantly across all age categories for both the men and women. Exercise and BMI were major determinants for Apo A-I and B levels. The 10th percentile of Apo A-I concentration was 109 mg/dL in the men and 113 mg/dL in the women, and the 90th percentile of Apo B concentration was 131 mg/dL in the men and 118 mg/dL women. Conclusions : For the prevention of coronary artery disease, we recommend that for individuals in the 10th percentile of concentration for Apo A-I and the 90th percentile of concentration for Apo B, active preventive interventions such as weight loss and exercise should be taken. This study, within its limitations, may be useful for evaluating apolipoprotein A-I and B concentrations in Korean adults.

• Korean Journal of Fisheries and Aquatic Sciences
• /
• v.51 no.2
• /
• pp.127-134
• /
• 2018

Arteriosclerosis is the major cause of coronary artery and cerebrovascular disease, which are leading causes of death. Pro-inflammatory cytokines induce injury to vascular endothelial cells by increasing cell adhesion molecules, leading to vascular inflammation, a major risk factor for the development of arteriosclerosis. In the current study, we investigated the inhibitory effect of enzymatic hydrolysate from Japanese mud shrimp Upogebia major on the inflammation of tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$)-stimulated human umbilical vein endothelial cells (HUVECs). We first evaluated the antioxidant and angiotensin I-converting enzyme (ACE) inhibitory activities of eight U. major enzymatic hydrolysates: alcalase, papain, ${\alpha}$-chymotrypsin (${\alpha}-Chy$), trypsin, pepsin, neutrase, protamex and flavourzyme. Of these, ${\alpha}-Chy$ exhibited potent antioxidant and ACE inhibitory activities. The ${\alpha}-Chy$ hydrolysate was fractionated by two ultrafiltration membranes of 3 and 10 kDa. The ${\alpha}-Chy$ hydrolysate of U. major and its molecular weight cut-off fractions resulted in a significant reduction in NO production and a decrease in cell adhesion molecules [vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) and endothelial-selectin (E-selectin)] and pro-inflammatory cytokines [interleukin-6 (IL-6), interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1)] in $TNF-{\alpha}$-stimulated HUVECs. These results suggest that enzymatic hydrolysate from U. major can be used in the control and prevention of vascular inflammation and arteriosclerosis.