Differences of the Exercise Capacity According to Left Ventricular Geometrical Changes and Its Associated Factors in Hypertensive Patients with Isolated Diastolic Dysfunction

BACKGROUND: Left ventricular(LV) adaptation to high blood pressure produces unique geometrical change, which is closely associated with the prognosis and quality of life in hypertensive patients irrespective of the presence of LV hypertrophy. Exercise capacity assessed by treadmill test(TMT) can provide prognostic information in these patients. We evaluated relationship between LV geometry and exercise capacity in hypertensive patients with isolated diastolic dysfunction. METHODS: According to the echocardiographic results, 109 patients with essential hypertension, who performed TMT for estimating exercise capacity, were classified as having normal LV geometry (NG, n=40) or concentric LV geometry (CG, n=69). Patients with concentric LV geometry were categorized into moderate (n=55) or marked (n=14) CG on the basis of the criteria previously reported. Conventional echocardiographic and tissue Doppler imaging indices were obtained with standard techniques. RESULTS: There were no differences in age, gender and resting heart rate between NG and CG. Maximal exercise time was longer in NG than in CG (617.3+/-131.5 vs. 566.0+/-155.0 seconds, p<0.05). Late diastolic mitral annular velocity (AO) exhibited a significant correlation with maximal exercise time in moderate and marked CG (r=0.30 and 0.56, both p<0.05), which remained significant after multivariate linear regression analysis with variables such as age, LV mass, early to late mitral inflow ratio, AO velocity, LV ejection fraction and left atrial size, whereas such a correlation could not be found in NG. CONCLUSION: Since exercise performance decreases when there is LV concentric remodeling, LV geometry needs to be considered in the assessment of exercise capacity in patients with essential hypertension and isolated diastolic dysfunction. Atrial systolic function plays a crucial role in maintaining exercise capacity in these patients, especially in those with increased LV concentricity.

The Effects of Acupuncture on Fibronectin, Collagens and Laminin in the Burn Wound Healing of Rats / 체질인류학회지

The present study was performed to examine whether acupuncture can regulate the expression of extracellular matrix proteins that play important roles in burn wound healing of rat, such as fibronectin, type I and IV collagens, and laminin. Sprague-Dawley rats weighing 250~300 g were divided into 4 groups such as normal control group (C), only acupuncture treatment group (Ca), burn treatment group (B), and a group for acupuncture treatment after burn (Ba). We burned 15x25 mm in size for 15~18 seconds at lumbar area of rats with special iron adapter and acupunctured at 5~7 mm in diameter and 1 cm in depth using 0.25 mm x 50 mm acupuncture needle for 20 minutes in wound area. Rats in group Ca were acupunctured once, and rats in group Ba were acupunctured every 12 hours 3 times. Rats sacrificed at days 1, 3, 7, 15 and 20 after burn treatment. Histological changes were examined by azan staining methods and expression profiles of fibronectin, type I and IV collagens, and laminin were detected by immunohistochemical staining methods. The results we obtained were as follows: 1. At day 1, fibers in epidermis, dermis and subcutaneous tissue in both groups B and Ba were not observed. However groups B and Ba exhibited fibers stained mildly and moderately, respectively, in muscle and connective tissues. At day 20 , the level of fiber in group B which was comparable to group C was less than that of in B group. 2. At day 3, fibronectin in group Ba was observed in the muscle. At days 15 and 20, fibronectin was increased in epidermis and dermis of group Ba compared with those of group B. 3. Type I collagen in subcutaneous tissue was observed at days 1, 3 and 7 in both groups B and Ba. However type I collagen was observed only in group Ba at day 15. In the epidermis of group Ba, type I collagen was observed at day 3 and maintained until day 20, while observing only at day 20 in group B. 4. For type IV collagen, both groups B and Ba showed similar results. 5. For laminin, both groups B and Ba showed similar results except the 7th day results. However after day 15, laminin was stained moderately and mildly in groups Ba and B, respectively. These results suggest that acupuncture may improve the burn wound healing by increasing fibronectin and type I collagen.

The Effects of Acupuncture on TGF-beta1, TGF-beta3, EGF, and IL-6 in the Burn Wound Healing of Rats / 체질인류학회지

The present study was performed to examine whether acupuncture can regulate the expression of cytokines that play important roles in wound healing and morphological changes in the burn wound healing of rats, such as transforming growth factor (TGF)-beta1, TGF-beta3, epidermal growth factor (EGF), and interleukin-6 (IL-6). Sprague-Dawley rats weighing 250~300 g were divided into two control groups and two experimental groups. Among the control groups, no-treatment group was classified as C and acupuntured group as Ca. Among the experimental groups, burned group (n = 6) was classified as B and acupunctured group after burn (n = 6) as Ba. The lumbar area of rats was burned 15 x 25 mm in size for 15~18 seconds with special small iron adapter and acupunctured at 5~7 mm in diameter and 1 cm in depth using 0.25 mm x 50 mm acupuncture needle for 20 minutes in wound area. Rats in group Ca were acupunctured once. Rats in group Ba were acupunctured every 12 hours 3 times. Rats were sacrificed at days 1, 3, 7, 15 and 20 after burn treatment. Morphological changes were examined by hematoxylin-eosin staining methods. The expression profiles of TGF-beta1, TGF-beta3, EGF and IL-6 were detected by immunohistochemical staining methods. The results we obtained were as follows: 1. In gross observation, the burn wounds were less odorous and cleaner in the acupunctured group (Ba) compared with those of no-acupuncture group (B). 2. Reepithelialization and formation of panniculus carnosus and granulation tissue were more prominent at days 3 and 7 in the acupunctured group Ba than group B. However, this difference was disappear at day 15. 3. In the muscle of group B, TGF-beta1 was observed after day7. However, in group Ba, TGF-beta1 was observed as early as days 1 and 3 and rapidly turnovered at day 7. 4. For TGF-beta3, both B and Ba groups showed similar results. 5. At day 3, EGF was observed in the subcutaneous tissue in both B and Ba groups. However, in day 7, EGF was rapidly decreased in Ba group compared with that of B. 6. For IL-6, both B and Ba groups showed similar results in epidermis, dermis, subcutaneous tissue and muscle. But, at day 3, IL-6 was rapidly decreased in theconnective tissue under the muscle in Ba group compared with that of B. These results suggest that acupuncture may improve the wound healing in the early stage by increasing the TGF-beta1 that is essential for the formation of extracellular matix and by decreasing EGF.