When blood vessels are damaged, a rapid hemostatic response should occur in order to lower blood loss and keep normal circulation, and platelet activation and aggregation are essential. Nevertheless, abnormal or excessive platelet aggregation can be a reason of cardiovascular diseases including thrombosis, atherosclerosis, and stroke. Therefore, the screening for a substance which can regulate platelet activation and suppress aggregation reaction is very important for treatment and prevention of cardiovascular diseases. Artemether is a methyl ether derivative of artemisinin, which is isolated from the antimalarial plant Artemisia annua, but research on platelet aggregation or its mechanisms is still insufficient. This study identified the effects of artemether on U46619-induced human platelet aggregation and their granule secretion (ATP and serotonin release). In addition, the effects of artemether on the phosphorylation of PI3K/Akt or MAPK, which are related to signal transduction in platelet aggregation, were studied. As the results, artemether significantly lowered PI3K/Akt and MAPK phosphorylation, which inhibited platelet aggregation through granule secretion (ATP and serotonin release) dose-dependently. Therefore, we suggest that artemether is an antiplatelet substance that regulates PI3K/Akt and MAPK pathway and is of value as a therapeutic and preventive agent for platelet-derived cardiovascular diseases.
Estrogen is crucial in regulating food intake, energy expenditure, glucose metabolism, and lipid metabolism. During menopause, the decline in estrogen levels predisposes women to weight gain, abdominal obesity, insulin resistance, type 2 diabetes, hypertension, and cardiovascular disease (CVD). Menopausal hormone therapy (MHT) prevents weight gain, improves lipid metabolism by lowering low-density lipoprotein cholesterol while raising high-density lipoprotein cholesterol, and delays the onset of type 2 diabetes in menopausal women. The effect of MHT on CVD in menopausal women remains controversial. The Women's Health Initiative study was terminated prematurely after it revealed that hormone administration increased the risk of myocardial infarction, stroke, and thromboembolism. However, some studies have found that MHT had no effect or decreased the risk of CVD. The inconsistent results were likely due to multiple factors, including the timing of hormone therapy initiation, duration of therapy, type and dosage, and presence or absence of CVD risk factors at the start of treatment. Despite its benefits in terms of managing weight gain and reducing the risk of type 2 diabetes, dyslipidemia, and CVD associated with obesity, it is not recommended as the primary therapy for weight loss or diabetes prevention. MHT is primarily indicated for postmenopausal women, who are likely to benefit from its potential to prevent weight gain and improve lipid metabolism.
Normal activation of platelets and their aggregation are crucial during hemostasis process. It appears excessive or abnormal aggregation of platelets may bring about cardiovascular diseases like stroke, atherosclerosis, and thrombosis. For this reason, finding a substance that can regulate platelet aggregation or suppress aggregation will aid in the prevention and treatment of cardiovascular diseases. Artemisinin, a compound derived from Artemisia or Scopolia plants, has shown potential in various areas such as anticancer and Alzheimer's disease research. However, the specific role and mechanisms by which artemisinin influences platelet activation and thrombus formation are not yet fully understood. This study investigated the effects of artemisinin on platelet activation and thrombus formation. This study examined the effect of artemisinin on regulation of U46619-induced platelet aggregation, granule secretion. In addition, the effects of artemisinin on phosphorylation of PI3K/Akt and MAPK pathway involved in platelet aggregation was studied. As a result, artemisinin significantly downregulated of PI3K/Akt and MAPK pathway. In addition, artemisinin significantly reduced granule secretion, and platelet aggregation was inhibited by artemisinin. Therefore, we suggest that artemisinin is an anti-platelet substance that regulates PI3K/Akt and MAPK pathway and is valuable as a therapeutic and preventive agent for platelet-derived cardiovascular disease.
본 논문의 목적은 Ethyl Benzene 플랜트의 공정에서 과압 현상이 Column 상부의 반응폭주 및 화재 폭발의 원인이 되기 때문에 안전장치시스템의 신뢰도가 압력방출밸브가 요구하는 안전건전성수준으로 설계되어 있는지를 정량적으로 분석한 것이다. 압력방출밸브의 요구시 실패확률은 일반신뢰도 자료 조사결과를 근거로 하여 안전장치시스템에 대한 안전건전성수준의 목표등급을 SIL3으로 설정하였고, 이에 대한 PFD를 1.00E-3에서 1.00E-4로 결정하였다. 신뢰도 모델의 구축 및 결함수 분석기법을 이용하여 SIS의 요구시 실패확률에 대한 정량화를 수행한 결과 SIS에 대한 PFD는 Benzene Prefractionator Column, Benzene Column, EB Column에 대해 각각 8.97E-04, 5.37E-04, 5.37E-04로 계산되었다. 따라서 SIS의 신뢰도가 SIL3 등급에 요구되는 안전건전성수준으로 설계되어 있다고 판단되며 컨트롤밸브에 대한 6개월 주기의 Partial Stroke Test가 수행될 경우 각 Column의 SIS는 약 $22{\sim}27%$의 신뢰도 향상이 기대된다.
Objective : To develop a boner understanding of the relationship between weight status and the prevalence of obesity related diseases in the Korean population. Methods : The 1998 Korean National Health and Nutrition Survey was used and 10,880 persons who had previously taken health examinations were selected for study. The Korean Society for the Study of Obesity's classification of weight status was used. Hypertension, diabetes mellitus, dyslipidemia, osteoarthritis, chronic heart disease, stroke were included as obesity related disease. A logistic regression model was developed to estimate the prevalence odds ratio by obesity class adjusted for demographic and socioeconomic factors and we converted the odds ratio to a prevalence ratio using the base line prevalence of disease to aid in the interpretation of the ratios. Results : The prevalence of obesity was 26.3% based on the KSSO classification $(BMI\geq25)$. A graded increase in the prevalence ratio was observed with increasing severity of overweight and obesity for all health outcomes with the exception of chronic heart disease in men and stroke in both men and women. With normal weight individuals as the reference, for men who were younger than 50 years, the prevalence ratios were highest for hypertension BMI<23-25: 1.70(95% CI=1.41-2.05), 25$BMI\geq30$: 4.83(95% CI=3.70-5.84). The prevalence ratios for dyslipidemia were as high as hypertension, but were lower than hypertension for diabetes mellitus and osteoarthritis. Prevalence ratios generally were greater in younger adults. The prevalence of having 2 or more obesity related diseases increased with weight status category, except in people who were older than 50 years. Conclusions : Based on results, obesity is an increasingly important health problem in Korea and the disease burden increases according to weight status. For Korean adults, the strongest relationship was seen between weight status and hypertension and dyslipidemia. In older people the impact of excess weight and obesity is stronger than that seen in younger people. Increased efforts in the study of obesity and prevention and treatment of obesity and obesity related disease are required.
Objective : Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients with acute stroke. This study aimed to analyze the effects of changes in mechanical thrombectomy protocol before and after the COVID-19 pandemic on procedure time and patient outcomes and to identify factors that significantly impact procedure time. Methods : The last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization times of 88 patients (45 treated with conventional pre-COVID-19 protocol and 43 with COVID-19 protection protocol) were retrospectively analyzed. The recanalization time, success rate of mechanical thrombectomy, and modified Rankin score of patients at discharge were assessed. A multivariate analysis was conducted to identify variables that significantly influenced the time delay in the door-to-puncture time and total procedure time. Results : The door-to-imaging time significantly increased under the COVID-19 protection protocol (p=0.0257) compared to that with the conventional pre-COVID-19 protocol. This increase was even more pronounced in patients who were suspected to be COVID-19-positive than in those who were negative. The door-to-puncture time showed no statistical difference between the conventional and COVID-19 protocol groups (p=0.5042). However, in the multivariate analysis, the last-normal-to-door time and door-to-imaging time were shown to affect the door-to-puncture time (p=0.0068 and 0.0097). The total procedure time was affected by the occlusion site, last-normal-to-door time, door-to-imaging time, and type of anesthesia (p=0.0001, 0.0231, 0.0103, and 0.0207, respectively). Conclusion : The COVID-19 protection protocol significantly impacted the door-to-imaging time. Shortening the door-to-imaging time and performing the procedure under local anesthesia, if possible, may be required to reduce the door-to-puncture and door-to-recanalization times. The effect of various aspects of the protection protocol on emergency thrombectomy should be further studied.
Objectives : This study was aimed to survey the perception of public official on public health promotion programs in Traditional Korean Medicine (PHPP-TKM). Methods : Data were collected from 129 public officials who were in charge of PHPP-TKM business in the public health centers using the structured questionnaire. Collected data were analyzed through frequency analysis and T-test using SPSS 13.0. Results : Even though stroke prevention programs are implemented most often at present, respondents hope to practice dementia prevention programs in the future. The obstructive factor was measured by 5-point Likert scale, and the most obstructive factor was that there were neither standard manuals nor methodological guidelines for the programs($3.73{\pm}0.97$). The second most obstructive factor was that TKM-PHPP duplicated other public health programs($3.67{\pm}1.07$). The plan to activate TKM-PHPP was also measured by 5-point Likert scale. The most suggested plan was to develop competitive programs ($4.20{\pm}0.88$). The second most suggested plan was that of various integration of public health programs ($4.14{\pm}0.80$). Conclusions : The result of survey questionnaire suggests to develop various integrated programs, and to draw up a standard manual to activate the TKM-PHPP in public health centers.
Background: Gestational trophoblastic neoplasia (GTN) is a spectrum of disease with abnormal trophoblastic proliferation. Treatment is based on FIGO stage and WHO risk factor scores. Patients whose score is 12 or more are considered as at extremely high risk with a high likelihood of resistance to first line treatment. Optimal therapy is therefore controversial. Objective: This study was conducted in order to summarize the regimen used for extremely high risk or resistant GTN patients in our institution the in past 10 years. Materials and Methods: All the charts of GTN patients classified as extremely high risk, recurrent or resistant during 1 January 2002 to 31 December 2011 were reviewed. Criteria for diagnosis of GTN were also assessed to confirm the diagnosis. FIGO stage and WHO risk prognostic score were also re-calculated to ensure the accuracy of the information. Patient characteristics were reviewed in the aspects of age, weight, height, BMI, presenting symptoms, metastatic area, lesions, FIGO stage, WHO risk factor score, serum hCG level, treatment regimen, adjuvant treatments, side effects and response to treatment, including disease free survival. Results: Eight patients meeting the criteria of extremely high risk or resistant GTN were included in this review. Mean age was 33.6 years (SD=13.5, range 17-53). Of the total, 3 were stage III (37.5%) and 5 were stage IV (62.5%). Mean duration from previous pregnancies to GTN was 17.6 months (SD 9.9). Mean serum hCG level was 864,589 mIU/ml (SD 98,151). Presenting symptoms of the patients were various such as hemoptysis, abdominal pain, headache, heavy vaginal bleeding and stroke. The most commonly used first line chemotherapeutic regimen in our institution was the VAC regimen which was given to 4 of 8 patients in this study. The most common second line chemotherapy was EMACO. Adjuvant radiation was given to most of the patients who had brain metastasis. Most of the patients have to delay chemotherapy for 1-2 weeks due to grade 2-3 leukopenia and require G-CSF to rescue from neutropenia. Five form 8 patients were still survived. Mean of disease free survival was 20.4 months. Two patients died of the disease, while another one patient died from sepsis of pressure sore wound. None of surviving patients developed recurrence of disease after complete treatment. Conclusions: In extremely high risk GTN patients, main treatment is multi-agent chemotherapy. In our institution, we usually use VAC as a first line treatment of high risk GTN, but since resistance is quite common, this may not suitable for extremely high risk GTN patients. The most commonly used second line multi-agent chemotherapy in our institution is EMA-CO. Adjuvant brain radiation was administered to most of the patients with brain metastasis in our institution. The survival rate is comparable to previous reviews. Our treatment demonstrated differences from other institutions but the survival is comparable. The limitation of this review is the number of cases is small due to rarity of the disease. Further trials or multicenter analyses may be considered.
Objectives: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. Methods: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. Results: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). Conclusions: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.
Objectives: The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly. Methods: A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders. Results: In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants. Conclusions: Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.
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