The Relationship Between Nocturia and Mortality: Data From the National Health and Nutrition Examination Survey / 대한배뇨장애요실금학회지

Purpose@#We investigated the relationship between nocturia and mortality risk in the United States. @*Methods@#Data were obtained from the National Health and Nutrition Examination Survey 2005–2010. Mortality data were obtained by linking the primary database to death certificate data found in the National Death Index with mortality follow-up up to December 31, 2015. Nocturia was defined based on symptoms reported in the symptom questionnaire. We categorized patients into 2 groups: mild nocturia (2–3 voidsight) and moderate-to severe nocturia (≥4 voidsight). Multiple Cox regression analyses were performed with adjustment for confounding variables at the baseline survey. @*Results@#This study included 9,892 adults (4,758 men, 5,134 women). Nocturia occurred in 3,314 individuals (33.5%). Nocturia was significantly associated with all-cause mortality (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.10–1.39) and cardiovascular disease (CVD) mortality (HR, 1.55; 95% CI, 1.19–2.01). Moreover, the mortality risk increased with increasing nocturia severity. Further analysis with propensity score matching showed that nocturia was still significantly associated with all-cause mortality and CVD mortality. In subgroup analysis according to sex, nocturia was significantly associated with allcause mortality and CVD mortality in men. In women, moderate-to-severe nocturia was significantly associated with allcause mortality and CVD mortality. In subgroup analysis according to cardio-metabolic diseases, nocturia was associated with CVD mortality in patients with diabetes mellitus, hypertension, dyslipidemia, or CVD at baseline. In subgroup analysis of patients without diabetes mellitus, hypertension or CVD, nocturia was significantly associated with all-cause mortality. @*Conclusions@#Nocturia was significantly associated with mortality in men and women after adjusting for major confounding factors.

Alpha-Blocker Treatment Response in Men With Lower Urinary Tract Symptoms Based on Sympathetic Activity: Prospective, Multicenter, Open-Labeled, Observational Study / 대한배뇨장애요실금학회지

PURPOSE: In this study, we compared the treatment outcomes for an alpha-blocker between 2 groups of men, one with high sympathetic activity (HSA) and another with low sympathetic activity (LSA) or normal sympathetic activity. METHODS: A total of 159 men (> or =50 years of age) with lower urinary tract symptoms resulting from benign prostatic hyperplasia were analyzed. We assigned patients to groups according to their sympathetic activity, which was evaluated by heart ratevariability measurements. HSA was defined as a low frequency/high frequency ratio greater than 1.6. All patients received 10mg of alfuzosin once a day for 12 weeks. The primary end point was a change in the total International Prostate SymptomScore (IPSS) at 12 weeks from baseline. RESULTS: Sixty-seven men were assigned to the HSA group and 92 men were assigned to the LSA group. The baseline characteristics were not significantly different between the 2 groups, and the response to alfuzosin was good in both groups. Themean total IPSS change was not different between the groups. Both groups were not significantly different with respect to the changes in maximal flow rate, IPSS voiding or storage symptom subscores, quality of life, and rates of adverse drug events. TheHSA group showed a similar willingness to continue treatment compared to the LSA group, although their treatment satisfaction rating was lower. CONCLUSIONS: The therapeutic effects of alfuzosin did not differ in regards to the differences in sympathetic activity, but treatment satisfaction ratings were lower in the HSA group.

The Correlation Between the Treatment Efficacy and the Sympathetic Activity in Men With Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

PURPOSE: In this study, we examined the difference in the treatment efficacy depending on the sympathetic activity in men with lower urinary tract symptoms (LUTS). METHODS: In the current single-center, retrospective study, we evaluated a total of 66 male patients aged 40-70 years of age, presenting with LUTS, whose International Prostate Symptom Score (IPSS) exceeded 8 points. They had a past 3-month history of taking alfuzosin XL, and their heart rate variability (HRV) was measured before and after the treatment. In addition, we also recruited 39 healthy volunteers who visited a health promotion center for a regular medical check-up. They were aged between 40 and 70 years and had an IPSS of <8 points. We divided the patients with LUTS into two groups: the groups A and B, based on a low frequency/high frequency (LF/HF) ratio of 1.7, which was the mean value of the LF/HF ratio in the healthy volunteers. After a 3-month treatment with alfuzosin XL, we compared treatment outcomes, based on the IPSS and peak urine flow rate, between the two groups. RESULTS: A 3-month treatment with alfuzosin XL, comprising the measurement of the HRV, was performed for the 23 patients of the group A (23/38) and 17 of the group B (17/28). After a 3-month treatment with alfuzosin XL, total IPSS and IPSS questionnaire 2 and 5 were significantly lower in the group A as compared with the group B. But this was not seen in the group B. Furthermore, there were no significant differences in other parameters, such as maximal flow rate and IPSS storage subscore, between the two groups. CONCLUSIONS: Our results indicate that the treatment efficacy was lower in patients with sympathetic hyperactivity as compared with those with sympathetic hypoactivity. Thus, our results will provide a basis for further studies to clarify causes of LUTS in a clinical setting.

Effect of Low Molecular Weight Heparin on Plasma Thrombin-Antithrombin Complex and Tissue Factor Pathway Inhibitor in Patients with Coronary Artery Disease / 대한혈액학회지

BACKGROUND: The anticoagulant efficacy of low molecular weight heparin (LMWH) as an alternative substitute for standard heparin (SH) was evaluated by measuring thrombin-antithrombin complex (TAT) and tissue factor pathway inhibitor (TFPI). METHODS: Twenty-two patients with coronary artery disease (CAD) were divided into three groups and plasma heparin concentration, platelet count, aPTT, TAT and TFPI before and after injection of SH and LMWH were measured. RESULTS: Plasma heparin concentrations were well correlated after the injection of heparin in group B (LMWH 200 U/kg) and C (LMWH 240 U/kg), but not in group A (SH). Platelet counts were not decreased in most patients and life-threatened bleeding was not observed in any patients. APTT prolongations were observed in all patients of SH group, but not in any patients of B and C. TAT levels were not significantly different between groups. TFPI levels were not significantly different between groups. Heparin levels were well correlated with TFPI levels, but not with TAT levels. CONCLUSION: The anticoagulant effect of LMWH up to 240 U/kg/D was not superior over SH in CAD patients, although it has several merits such as no requirement of aPTT monitoring or better predictability.

The Role of Helicobacter pylori in Cirrhotic Patients with Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND AND AIMS: The overall age-matched incidence of gastroduodenal ulcers was considerably higher in cirrhotic patients compared to the general population. There are several possible underlying mechanisms which may explain the ulcerogenic factors in cirrhotic patients. Recently, Helicobacter pylori (H. pylori) was proven as the cause of peptic ulcer disease in the general population. But the role of H. pylori infection in the pathogenesis of peptic ulcers of cirrhotic patients has not been clearly elucidated. The purpose of this study was to determine the role of H. pylori infection in cirrhotic patients with peptic ulcers. METHODS: From 1995 to 1997, 105 patients with histologically or radiologically proven liver cirrhosis (LC) who received panendoscopic examination due to presence of any upper gastrointestinal symptoms were studied. During endoscopic examination, a CLO (campylobacter like organism) test or gastric antral mucosal biopsy was performed in all patients. The severity of LC assessed by Child's criteria revealed that 31 patients had Child's A, 26 patients Child's B, and the remain 48 patients, Child's C. Child B or C was classified as decompensated LC. An esophageal varix was present in 73 patients or absent in 32. RESULTS: There was no statistical difference in the H. pylori prevalance between the ulcer group and non-ulcer group (67% vs 52%). In Child A group, the H. pylori prevalence was significantly higher in the ulcer group when compared with the non-ulcer group (87% vs 50%, p<0.05). In contrast, in the Child B or C group, there was no statistical difference between the ulcer group and non-ulcer group. In the abscence of esophageal varix, the ulcer group showed significantly higher prevalence of H. pylori than the non-ulcer group (87% vs 59%, p<0.05). But in the esophageal variceal group, there was no significant difference in the H. pylori prevalence between the ulcer and non-ulcer group (60% vs 40%). CONCLUSIONS: These observations suggest that H. pylori infection may play a role in the pathogenesis of peptic ulcer in compensated cirrhotic patients. However, in cirrhotic patients with decompensation or an esophageal varix, the association between H. pylori infection and peptic ulcers was weak, so other factors (portal hypertension etc.) should be considered as more potent etiology of peptic ulcers in cases of decompensated cirrhosis.

Comparison of left ventricular hypertrophy between hypertensives and chronic renal disease patients: Echocardiographic Study / 대한내과학회지

OBJECTIVES: Left ventricular hypertrophy (LVH) is one of the most common echocardiographic findings and an important prognostic factor for cardiovascular mortality in hypertensives and chronic renal failure patients. To evaluate the prevalence and the types of LVH, and left ventricular systolic and diastolic functions as worsening of renal function, and to elucidate the risk factors for LVH, we performed this study retrospectively in normal populations, hypertensives, and renal failure with or without hemodialysis. METHODS AND SUBJECTS: We recruited the study population among the patients who had taken echocardiography at Pun-Dang CHA Hospital from July, 1995 to June, 1997. They are consisted of 54 patients for normal control, 53 patients of hypertensives, 31 patients of mild renal failure with less than 4.5 mg/dl of serum creatinine (Group I), 29 patients of moderate renal failure with more than 4.5 mg/dl of serum creatinine (Group II), and 47 patients of end stage renal disease with hemodialysis (Group III). The echocardiography was performed with all standard strategies including 2 dimension, M mode, and Doppler signals. RESULTS: 1) Among the baseline characteristics, the body mass index only significantly increased in hypertensives compared with group II and III.2) The prevalences of LVH in each groups were 5.6% in control group, 49.1% in hypertensives, 83.8% in group I, 89.7% in group II, and 100% in group III respectively. And the pevalences of concentric LVH were 5.6%, 43.3%, 41.9%, 34.5%, and 25.5% and those of the eccentric hypertrophy were 0.0%, 5.7%, 41.9%, 55.2%, and 74.5% respectively. The prevalence of eccentric hypertrophy increased according to deterioration of renal function.3) The left ventricular mass index was significantly higher in hypertensives, Group I, Group II, and Group III than normal control and the left ventricular volume index was greater in all renal failure patients compared with controls and hypertensives.4) In pre-hemodialysis renal failure patients, the types of LVH were consisted of 8 of normal heart (Group A), 23 of concentric LVH (Group B), and 29 of eccentric LVH (Group C). The systolic blood pressure and mean arterial pressure were significantly higher in group C than group A but there was no significant difference between group C and B. The RBC volume was significantly decreased in group B and C compared with group A. The echocardiographic end diastolic interventricular septal thickness and posterior wall thickness were significantly thicker in group B than others but end diastolic LV dimension, LV mass index, and LV volume index were significantly increased in group C than group B and A. The LV ejection fraction and fractional shortening as markers of LV systolic function in group C revealed the lowest level among three groups. The E velocity among the Doppler study profiles was significantly higher in group C than others.5) In hemodialysis group, all the patients had any types of LV hypertrophic changes. The concentric LVH group (group B) had significantly higher systolic blood pressure and mean arterial pressure than eccentric LVH (group C) but there was no difference in diastolic blood pressure between two groups. The echocardiographic interventricular septum and posterior wall were thicker in group B than group C but end diastolic LV dimension and LV volume were significantly higher in group C than group B.6) The LV mass index in pre-hemodialysis group had positive relationship with blood pressure and serum urea nitrogen level and the LV volume index was positively correlated with systolic blood pressure and mean blood pressure.7) The LV mass index in hemodialysis group had positive relationship with age and systolic blood pressure and LV volume index was positively correlated with serum urea nitrogen level but negatively correlated with blood pressure. CONCLUSION: The prevalence of LVH was much higher in renal failure group than hypertenssives and the proportion of eccentric LVH was increased with worsening of renal function. Although the arterial hypertension is the most important risk factor for LVH, this finding suggested existence of other contributing risk factors for LVH in chronic renal failure, which included uremia, anemia, and age.