A Comparative Systematic Analysis of The Influence of Microplastics on Colon Cells, Mouse and Colon Organoids

BACKGROUND@#Microplastics (MPs) are small fragments from any type of plastic formed from various sources, including plastic waste and microfibers from clothing. MPs degrades slowly, resulting in a high probability of human inhalation, ingestion and accumulation in bodies and tissues. As its impact on humans is a prolonged event, the evaluation of its toxicity and influence on human health are critical. In particular, MPs can enter the human digestive system through food and beverage consumption, and its effect on the human colon needs to be carefully examined. @*METHODS@#We monitored the influence of small MPs (50 and 100 nm) on human colon cells, human colon organoids and also examined their toxicity and changes in gene expression in vivo in a mouse model. @*RESULTS@#The data suggested that 5 mg/mL concentrations of 50 and 100 nm MPs induced a[ 20% decrease in colon organoid viability and an increase in the expression of inflammatory-, apoptosis- and immunity-related genes. In addition, in vivo data suggested that 50 nm MPs accumulate in various mouse organs, including the colon, liver, pancreas and testicles after 7 d of exposure. @*CONCLUSION@#Taken together, our data suggest that smaller MPs can induce more toxic effects in the human colon and that human colon organoids have the potential to be used as a predictive tool for colon toxicity.

The Effects of the Metabolic Syndrome on the Total Medical Charge / 보건행정학회지

BACKGROUND: This study purposed to analyze the effects of metabolic syndrome on the total medical charge of patients. METHODS: 2013 National Health Insurance Service sample research database (eligibility database, medical database, and health examination database) was used for this study. Gamma regression was applied to analyze the effects of metabolic syndrome on the total medical charge and logistic regression was used to determine the probability of medical charge which was higher than the third quartile. Sociodemographic characteristics (age and household income), health behavior factors (smoking, drinking, exercise, and body mass index), and disease related factors (family history and metabolic syndrome) were included as the independent variables. RESULTS: people who had metabolic syndrome spent more medical expenses than those without metabolic syndrome both in man and woman group. The standard regression coefficient was 0.09 (p<0.001) in man with metabolic syndrome and 0.16 (p<0.001) in woman. In addition, woman with metabolic syndrome spent more than the third quartile of medical charge. The odds ratios was 1.04 (p=0.16) for man with metabolic syndrome and 1.18 (p=0.013) for woman. CONCLUSION: people with metabolic syndrome spent more medical charge, so it will need to consider policy interventions for preventing the incidence and management of metabolic syndrome in Korean people.

The Long-term Clinical Outcome after Corneal Collagen Cross-linking in Korean Patients with Progressive Keratoconus

PURPOSE: To evaluate the long-term clinical effectiveness and safety of corneal collagen cross-linking (CXL) in progressive keratoconus compared with untreated contralateral eyes. METHODS: In this retrospective study, nine eyes of nine patients with progressive keratoconus who received CXL (treatment group) and nine untreated contralateral eyes with keratoconus (control group) were included. All patients were followed for at least 5 years and assessed with best-corrected visual acuity, maximum keratometry, mean keratometry, corneal astigmatism, and corneal thickness. Clinical data were collected preoperatively and at 1, 3, 6, 12, 24, 36, 48, and 60 months, postoperatively. RESULTS: Mean best-corrected visual acuity improved significantly from 0.58 ± 0.37 logarithm of minimum angle of resolution preoperatively to 0.39 ± 0.29 logarithm of minimum angle of resolution at 5 years after corneal CXL (p = 0.012). There was significant flattening of the maximum keratometry and mean keratometry from preoperative values of 63.39 ± 10.89 and 50.87 ± 6.27 diopter (D) to postoperative values of 60.89 ± 11.29 and 49.54 ± 7.23 D, respectively (p = 0.038, 0.021). Corneal astigmatism decreased significantly from 7.20 ± 1.83 D preoperatively to 5.41 ± 1.79 D postoperatively (p = 0.021). The thinnest corneal thickness decreased from 434.00 ± 54.13 to 365.78 ± 71.58 µm during 1 month after treatment, then increased to 402.67 ± 52.55 µm at 5 years, which showed a statistically significant decrease compared to the baseline (p = 0.020). In the untreated contralateral eyes, mean keratometry increased significantly at 2 years compared with the baseline (p = 0.043). CONCLUSIONS: CXL seems to be an effective and safe treatment for halting the progression of keratoconus over a long-term follow-up period of up to 5 years in progressive keratoconus.

Implications of the concept of the standard of care on self-regulation and medical ethics based on medical regulation

Self-regulation has a long tradition in countries such as Germany. In healthcare, a professional level of quality is known as the standard of care, but the concept is not defined by law. In practice, this concept has developed into physician self-regulation. In addition, a normative judgment about the medical standard can be understood as a concept developed by precedent related to medical malpractice cases. The law functions reactively rather than proactively. However, clinical ethics has a wider scope within the legal field than simply the corrective function of medical liability. This study focuses on a legal approach to self-regulation, the normative concept of medical standards in legal criteria, and its requirement. Regarding civil responsibility, the paper reviews an assessment of autonomy in the determination of the medical standard. In comparison to the disciplinary system of Germany's criminal law, the offenses of doctors under Korean law is considerably below the international standards for self-regulation. In fact, discipline for malpractice is effectively regulated by the state. Therefore, when doctors take an ethical approach, it can help protect patients and at the same time raise a sense of professional responsibility. This plays an important role in the complementary relationship between medical ethics as a preventive function and the standard of care or practice standards as a part of self-regulation. In conclusion, self-regulation can have a much more effective and positive impact on relationships between the patient and the doctor and strengthen preventive measures for the patient's safety within medical regulation.

The Immunomodulatory Activity of Mori folium, the Leaf of Morus alba L., in RAW 264.7 Macrophages In Vitro

BACKGROUND: Immunoregulatory elements have emerged as useful immunotherapeutic agents against cancer. In traditional medicine, Mori folium, the leaf of Morus alba L. (Moraceae), has been used for various medicinal purposes; however, the immunomodulatory effects have not been fully identified. We evaluated the immunoenhancing potential of water extract of Mori folium (WEMF) in murine RAW264.7 macrophages. METHODS: RAW264.7 cells were treated with WEMF for 24 hours and cell viability was detected by an MTT method. Nitric oxide (NO) levels in the culture supernatants were assayed using Griess reagent. The productions of prostaglandin E2 (PGE2) and immune-related cytokines was measured using ELISA detection kits. The mRNA and protein expression levels of Inducible NO synthase, COX-2, and cytokines were assayed by reverse transcription-PCR and Western blotting, respectively. The effect of WEMF on phagocytic activity was measured using a Phagocytosis Assay Kit. RESULTS: WEMF significantly stimulated the production of NO and PGE2 as immune response parameters at noncytotoxic concentrations, which was associated with the increased expression of inducible NO synthase and COX-2. The release and expression of cytokines, such as TNF-α, interleukin (IL)-1β, IL-6, and IL-10, were also significantly increased in response to treatment with WEMF. Moreover, WEMF promoted the macrophagic differentiation of RAW264.7 cells and the resulting phagocytosis activity. CONCLUSIONS: WEMF has the potential to modulate the immune function by regulating immunological parameters. Further studies are needed to identify the active compounds and to support the use of WEMF as an immune stimulant.

Single-dose oral toxicity of fermented rice extracts [FREs]: a 14-day observation

The aim of present research was to determine the acute oral toxicity of fermented rice extracts [FREs], in female and male ICR mice. To investigate the toxicity and identify target organs, FREs were orally administered once to male and female ICR mice at doses of 0 [vehicle control], 500, 1000, or 2000 mg/kg body weight [BW]. Effects on mortality, BW, and clinical signs were monitored over 14 days, including changes in the weights and histopathological characteristics of 14 organs, as described in the Korea Food and Drug Administration [KFDA] Guidelines [2009-116, 2009]. No treatment-related mortality was observed during the 14-day observation period in either gender. In addition, no FRE-related change was observed in BW or organ weight [OW], clinical indicators, or histopathological findings in this study. Our results suggest that the FRE is non-toxic in mice and is therefore likely to be safe for clinical use. The approximate LD and LD[50] in mice after single oral dose of FRE are greater than 2000 mg/kg in female and male ICR mice. Additionally, no specific target organ or negative clinical indicator was detected in this study.

Cutoff Value of Pharyngeal Residue in Prognosis Prediction After Neuromuscular Electrical Stimulation Therapy for Dysphagia in Subacute Stroke Patients

OBJECTIVE: To determine the cutoff value of the pharyngeal residue for predicting reduction of aspiration, by measuring the residue of valleculae and pyriformis sinuses through videofluoroscopic swallowing studies (VFSS) after treatment with neuromuscular electrical stimulator (VitalStim) in stroke patients with dysphagia. METHODS: VFSS was conducted on first-time stroke patients before and after the VitalStim therapy. The results were analyzed for comparison of the pharyngeal residue in the improved group and the non-improved group. RESULTS: A total of 59 patients concluded the test, in which 42 patients improved well enough to change the dietary methods while 17 did not improve sufficiently. Remnant area to total area (R/T) ratios of the valleculae before treatment in the improved group were 0.120, 0.177, and 0.101 for solid, soft, and liquid foods, respectively, whereas the ratios for the non-improved group were 0.365, 0.396, and 0.281, respectively. The ratios of the pyriformis sinuses were 0.126, 0.159, and 0.121 for the improved group and 0.315, 0.338, and 0.244 for the non-improved group. The R/T ratios of valleculae and pyriformis sinus were significantly lower in the improved group than the non-improved group in all food types before treatment. The R/T ratio cutoff values were 0.267, 0.250, and 0.185 at valleculae and 0.228, 0.218, and 0.185 at pyriformis sinuses. CONCLUSION: In dysphagia after stroke, less pharyngeal residue before treatment serves as a factor for predicting greater improvement after VitalStim treatment.

Single oral dose toxicity test of polycalcium, a mixed composition of polycan and calcium lactate-gluconate 1:9 [G/G] in SD rat

The object of this study was to obtain acute oral toxicity information of Polycalcium, a mixed composition of Polycan and Calcium lactate-gluconate 1:9 [g/g], in Sprague-Dawely [SD] rats. In order to investigate the toxicity and identify target organs, Polycalcium were once orally administered to female and male SD rats at dose levels of 2000, 1000, 500 and 0 [control] mg/kg body weights. The mortality, changes on body weight and clinical signs were monitored during 14 days after treatment with gross observation, changes on the organ weights and histopathology of principle organs and treatment sites based on the recommendation of KFDA Guidelines [2009-116, 2009]. As the results of single oral treatment of Polycalcium, no treatment related mortalities were observed within 14 days after end of treatment up to 2000 mg/kg, the limited dosage of rodents in the both genders. In addition, no Polycalcium treatment related changes on the body and organ weights, clinical signs, necropsy and histopathological findings were detected. The results obtained in this study suggest that the Polycalcium is non-toxic in rats. The LD[50] and approximate LD in rats after single oral dose of Polycalcium were considered over 2000 mg/kg in both female and male, respectively

Effects of Calcium Gluconate, a Water Soluble Calcium Salt on the Collagen-Induced DBA/1J Mice Rheumatoid Arthritis

This study examined the effects of calcium (Ca) gluconate on collagen-induced DBA mouse rheumatoid arthritis (CIA). A single daily dose of 200, 100 or 50 mg/kg Ca gluconate was administered orally to male DBA/1J mice for 40 days after initial collagen immunization. To ascertain the effects administering the collagen booster, CIA-related features (including body weight, poly-arthritis, knee and paw thickness, and paw weight increase) were measured from histopathological changes in the spleen, left popliteal lymph node, third digit and the knee joint regions. CIA-related bone and cartilage damage improved significantly in the Ca gluconate- administered CIA mice. Additionally, myeloperoxidase (MPO) levels in the paw were reduced in Ca gluconate-treated CIA mice compared to CIA control groups. The level of malondialdehyde (MDA), an indicator of oxidative stress, decreased in a dose-dependent manner in the Ca gluconate group. Finally, the production of IL-6 and TNF-alpha, involved in rheumatoid arthritis pathogenesis, were suppressed by treatment with Ca gluconate. Taken together, these results suggest that Ca gluconate is a promising candidate anti-rheumatoid arthritis agent, exerting anti-inflammatory, anti-oxidative and immunomodulatory effects in CIA mice.

Comparative Study of Low Doses of Rosuvastatin and Atorvastatin on Lipid and Glycemic Control in Patients with Metabolic Syndrome and Hypercholesterolemia

BACKGROUND/AIMS: This multicenter, open-labeled, randomized trial was performed to compare the effects of rosuvastatin 10 mg and atorvastatin 10 mg on lipid and glycemic control in Korean patients with nondiabetic metabolic syndrome. METHODS: In total, 351 patients who met the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome with low-density lipoprotein cholesterol (LDL-C) levels > or = 130 mg/dL were randomized to receive either rosuvastatin 10 mg (n = 173) or atorvastatin 10 mg (n = 178) for over 6 weeks. RESULTS: After 6 weeks of treatment, greater reductions in total cholesterol (- 35.94 +/- 11.38 vs. - 30.07 +/- 10.46%, p < 0.001), LDL-C (48.04 +/- 14.45 vs. 39.52 +/- 14.42%, p < 0.001), non-high-density lipoprotein cholesterol (- 42.93 +/- 13.15 vs. - 35.52 +/- 11.76%, p < 0.001), and apolipoprotein-B (- 38.7 +/- 18.85 vs. - 32.57 +/- 17.56%, p = 0.002) levels were observed in the rosuvastatin group as compared to the atorvastatin group. Overall, the percentage of patients attaining the NCEP ATP III goal was higher with rosuvastatin as compared to atorvastatin (87.64 vs. 69.88%, p < 0.001). Changes in glucose and insulin levels, and homeostasis model assessment of insulin resistance index were not significantly different between the two groups. The safety and tolerability of the two agents were similar. CONCLUSIONS: Rosuvastatin 10 mg was more effective than atorvastatin 10 mg in achieving NCEP ATP III LDL-C goals in patients with nondiabetic metabolic syndrome, especially in those with lower NCEP ATP III target level goals.

Diabetes, Insulin Resistance and Atherosclerosis Surrogates in Patients With Coronary Atherosclerosis

BACKGROUND AND OBJECTIVES: Undiagnosed diabetes mellitus (DM) or impaired glucose tolerance (IGT) is not uncommon in patients with coronary atherosclerosis and is known to be associated with abnormal scores for atherosclerosis surrogates. We sought to determine the prevalence of undiagnosed DM or IGT, and the association between insulin resistance (IR) and atherosclerosis surrogates in patients with coronary atherosclerosis. SUBJECTS AND METHODS: The study population consisted of 187 consecutive patients with angiographically proven coronary atherosclerosis (mean: 61 years old, 94 males). We measured carotid intima-media thickness (IMT) and flow mediated brachial artery dilatation (FMD). We also did oral glucose tolerance tests (OGTT), quantitative insulin-sensitivity check indexes (QUICKI) and homeostasis model assessment-IR (HOMA-IR). RESULTS: Abnormal OGTT was found in 164 patients (87.7%), even though there were only 63 known cases of DM (33.7%). There were 58 patients (31%) with newly diagnosed IGT and 43 patients (23%) with newly diagnosed DM. There were 71 patients (38%) who had IR (defined as measured HOMA-R > or =3.0). HOMA-IR showed a positive correlation with body mass index (BMI) (r=0.275, p<0.001) and triglycerides (r=0.2, p=0.01), whereas QUICKI had a negative correlation with BMI (r=-0.26, p<0.001), total cholesterol (r=-0.15, p=0.04), triglycerides (r=-0.21, p=0.004) and low-density lipoprotein-cholesterol (LDL-C) (r=-0.17, p=0.02). HOMA-IR and QUICKI were not significantly correlated with IMT or FMD. CONCLUSION: This study suggests that there is a high incidence of undiagnosed DM and IGT, but atherosclerosis surrogates are not associated with IR in patients with coronary atherosclerosis.

Ultrasound Elastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules / 대한내분비외과학회지

PURPOSE: The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness. METHODS: From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1~3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results. RESULTS: Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and negativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. CONCLUSION: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required.

Fruit Body Formation on Silkworm by Cordyceps militaris

Injection inoculation protocols for fruit body formation of Cordyceps militaris (C. militaris) were investigated to improve the incidence of infection in the silkworm species Bombyx mori (B. mori). Injection, with suspensions of C. militaris hyphal bodies into living silkworm pupae, was used to test for fruit body production. Use of Daeseungjam rather than Baegokjam or Keumokjam varieties of B. mori is thought to be suitable for infection by C. militaris. From mounting, nine-day-old to 11-day-old pupae showed the best incidence of infection with a 100 microL injection volume. Silkworm pupae injected with a hyphal suspension concentration of more than 2 x 105 colony-forming unit (cfu) recorded a greater than 96% incidence of infection. Also, fruit bodies of C. militaris were induced and produced at a light intensity between 500 and 1,000 lx.

A Case of Aortopulmonary Fistula Caused by a Huge Thoracic Aortic Aneurysm

Aortopulmonary fistula is an uncommon but often fatal condition resulting as a late complication of an aortic aneurysm. The most common cause is erosion of a false aneurysm of the descending thoracic aorta into the pulmonary artery, resulting in the development of a left-to-right shunt and leading to acute pulmonary edema and right heart failure. We report an our experience with aortopulmonary fistula as a rare complication associated with thoracic aortic aneurysm and high output heart failure.

A Study on Brand Personality and Employee's Self: Image Congruity and Job Satisfaction: Especially for Family Restaurant / 대한지역사회영양학회지

This day's research analyzed the difference between brand personality, self - image congruity, job satisfaction and their influences towards employees of family restaurants in order to suggest a plan which would induce researcher's interest as well as influencing diversification of management strategies toward dining-out business. The purpose of this research is to analyse the difference between brand personality, self - image congruity, job satisfaction and their influences towards employees of family restaurants. The survey questionnaires were distributed to 300 employees of family restaurants in Seoul from August 1th until August 30th 2009, and 257 of them were used for analysis. The top seven company's were chosen by base on data from 2009 Annual Dinner of the Korea. Statistics handling of this research used SPSS WIN 17.0 statistics package program, which performed frequency analysis, factor analysis, regrssion anlysis. The research result shows, first of all, the relationship between company's brand personality and personal self - image congruity, it shows that the company's brand personality has higher on 'ability/capability, loyalty/ fidelity, and strong' the personal self - image congruity appeared higher. The relationship between company's brand personality and social self-image congruity, it shows that the company's brand personality has higher on 'ability/ capability and loyalty/fidelity' the social self-image congruity appeared higher. Second of all, in a relation between the self-image congruity and job satisfaction, the personal self-image congruity has shown positive impact on job satisfaction. Third of all, in a relationship between the company's brand personality and job satisfaction, if 'interest or loyalty/fidelity' shows higher on brand personality, than job satisfaction has shown higher.

Prevalence and Significance of Carotid Plaques in Patients With Coronary Atherosclerosis

BACKGROUND AND OBJECTIVES: Carotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis. SUBJECTS AND METHODS: The study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7+/-10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm. RESULTS: Carotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p or =65 years), hypertension, and increased CIMT (> or =1.0 mm) were independent predictors of carotid plaque. Carotid plaque (odds ratio, 1.85; 95% confidence interval, 1.39-2.45; p<0.001) was an independent predictor of multivessel disease based on multivariate regression analysis. CONCLUSION: Carotid plaque was common (30.3%) in Korean patients with coronary atherosclerosis, but it is still relatively uncommon compared to Western populations. Carotid plaque was associated with old age, hypertension, and increased IMT, and was an independent predictor of multi-vessel disease.

Solitary Fibrous Tumor of the Sublingual Gland / 대한이비인후과학회지

Solitary fibrous tumor, a mesenchymal neoplasm that arises most commonly from the pleura of the lung, has been described in a variety of extrapleural sites including the abdominal cavity, soft tissue, upper respiratory tract and rarely in head and neck region. We present a rare case of solitary fibrous tumor that occurred in the sublingual gland. A 52-year old woman presented with a painless mass in the left side of the floor of mouth. The tumor was well-demarcated and easily dissected, and it showed highly cellular areas of spindle cells with pattern-less architecture alternating with hypocellular areas. The tumor cells were positive for CD34 but negative for cytokeratins and S-100 protein. During the 12 months of follow-up, there was no recurrence of tumor growth.

Open versus closed reduction of mandibular condyle fractures: A systematic review of comparative studies

Objective: The objective of this review was to provide reliable comparative results regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured mandibular condyle PATIENTS AND METHODS: Research of studies from MEDLINE and Cochrane since 1990 was done. Controlled vocabulary terms were used. MeSH Terms were "Mandibular condyle" AND "Fractures, bone". Only comparative study were considered in this review using the "limit" function. According to the criteria, two review authors independently assessed the abstracts of studies resulting from the searches. The studies were divided according to some criteria, and following were measured: Ramus height, condyle sagittal displacement, condyle Towns's image displacement, Maximum open length, Protrusion & Lateral excursion, TMJ pain, Malocclusion, and TMJ disorder. RESULTS: Many studies were analyzed to review the post-operative result of the two methods of treatment. Ramus height decreased more in when treated by closed reduction as opposed to open reduction. Sagittal condyle displacement was shown to be greater in closed reduction. Condyle Town's image condyle displacement had greater values in closed reduction. Maximum open length showed lower values in closed reduction. In protrusive and lateral movement, closed reduction was less than ORIF. Closed reduction showed greater occurrence of malocclusion than ORIF. However, post-operative pain and discomfort was greater in ORIF. CONCLUSION: In almost all categories, ORIF showed better results than CRIF. However, the use of the open reduction method should be considered due to the potential surgical morbidity and increased hospitalization time and cost. To these days, Endoscopic surgical techniques for ORIF (EORIF) are now in their infancy with the specific aims of eliminating concern for damage to the facial nerve and of reducing or eliminating facial scars. Before performing any types of treatment, patients must be understood of both of the treatment methods, and the best treatment method should be taken on permission.

A Case of Profuse Cerebrospinal Fluid Otorrhea with Common Cavity Cochlea in Adult / 대한이비인후과학회지

Cerebrospinal fluid (CSF) otorrhea with inner ear anomaly and common cavity anomaly in adults is very rare, especially as a first symptom except hearing loss. Surgical intervention is the primary treatment for profuse CSF leaks by cochlear anomaly. It can be treated when CSF leaks are encountered after cochlear implant surgery and are controlled with temporalis muscle plugs, fascia and fibrin glue. We should advise patients with congenital inner ear anomaly about sudden cerebrospinal fluid leaks or recurrent meningitis. We report a case of cerebrospinal fluid otorrhea with common cavity cochlea in an adult with a review of literature.

Increased carotid intima-media thickness in hypertensive patients is caused by increased medial thickness / 대한내과학회지

BACKGROUNDS/AIMS: It has been suggested that there is a differential response of the vasculature to systemic risk factors for atherosclerosis. We sought to evaluate the impact of hypertension on the carotid arterial wall using new methods that can measure each arterial wall layer. METHODS: The study subjects consisted of 163 patients who underwent carotid arterial scanning using high-resolution ultrasound that could measure the left carotid intima-media, intima, and media separately. The individual carotid arterial wall thickness was measured off-line by a new method using the Canny edge-detection algorithm. RESULTS: Hypertensive patients (n=79, mean age 61.8 years) had a higher prevalence of diabetes (31.6% vs 11.9%, p=0.004) and a lower level of HDL-cholesterol than did normotensive patients (41.8+/-11.0 mg/dL vs 45.7+/-10.0 mg/dL, p=0.019). Hypertensive patients had higher carotid intima-media thickness (CIMT, 0.81+/-0.21 mm vs 0.74+/-0.18 mm, p=0.003) and carotid medial thickness (CMT, 0.46+/-0.12 mm vs 0.42+/-0.09 mm, p=0.007) than did normotensive patients, whereas carotid intimal thickness (CIT) was not significantly different (0.34+/-0.04 mm vs 0.34+/-0.04 mm, p=0.196). Multivariate analysis revealed that the independent factors of CIMT were CMT (beta=0.915, p<0.001), hypertension (beta=0.076, p=0.008), age (beta=0.074, p=0.010), and sex (beta=-0.079, p=0.005). Pearson correlation coefficient between CIMT and CMT was higher (r=0.932, p<0.001 vs r=0.445, p<0.001) than that between CIMT and CIT. The correlation between CIMT and CMT was higher (r=0.940, p<0.001 vs r=0.910, p<0.001) in hypertensive patients than in normotensive patients, whereas that between CIMT and CIT was lower (r=0.344, p=0.002 vs r=0.583, p<0.001) in hypertensive patients. CONCLUSIONS: The increased CIMT is caused by increased CMT in hypertensive patients, and this finding is compatible with the medial hypertrophy seen in hypertension. The carotid medial layer should be the focus of attention in future studies looking at hypertensive patients.