Identifying Atrial Fibrillation With Sinus Rhythm Electrocardiogram in Embolic Stroke of Undetermined Source: A Validation Study With Insertable Cardiac Monitors

Background and Objectives@#Paroxysmal atrial fibrillation (AF) is a major potential cause of embolic stroke of undetermined source (ESUS). However, identifying AF remains challenging because it occurs sporadically. Deep learning could be used to identify hidden AF based on the sinus rhythm (SR) electrocardiogram (ECG). We combined known AF risk factors and developed a deep learning algorithm (DLA) for predicting AF to optimize diagnostic performance in ESUS patients. @*Methods@#A DLA was developed to identify AF using SR 12-lead ECG with the database consisting of AF patients and non-AF patients. The accuracy of the DLA was validated in 221 ESUS patients who underwent insertable cardiac monitor (ICM) insertion to identify AF. @*Results@#A total of 44,085 ECGs from 12,666 patient were used for developing the DLA. The internal validation of the DLA revealed 0.862 (95% confidence interval, 0.850–0.873) area under the curve (AUC) in the receiver operating curve analysis. In external validation data from 221 ESUS patients, the diagnostic accuracy of DLA and AUC were 0.811 and 0.827, respectively, and DLA outperformed conventional predictive models, including CHARGE-AF,C2HEST, and HATCH. The combined model, comprising atrial ectopic burden, left atrial diameter and the DLA, showed excellent performance in AF prediction with AUC of 0.906. @*Conclusions@#The DLA accurately identified paroxysmal AF using 12-lead SR ECG in patients with ESUS and outperformed the conventional models. The DLA model along with the traditional AF risk factors could be a useful tool to identify paroxysmal AF in ESUS patients.

A questionnaire survey on the diagnosis and treatment of Fabry nephropathy in clinical practice

Fabry nephropathy is characterized by a deficiency of lysosomal alpha-galactosidase A, which results in proteinuria and kidney disease. The ineffectiveness of enzyme replacement therapy (ERT) for severe kidney failure highlights the need for early detection and meaningful markers. However, because the diagnosis and treatment of Fabry disease can vary according to the expertise of physicians, we evaluated the opinions of Korean specialists. Methods: A questionnaire regarding the management of Fabry nephropathy was emailed to healthcare providers with the experience or ability to treat individuals with Fabry nephropathy. Results: Of the 70 experts who responded to the survey, 43 were nephrologists, and 64.3% of the respondents reported having treated patients with Fabry disease. Pediatricians are treating primarily patients with classic types of the disease, while nephrologists and cardiologists are treating more patients with variant types. Only 40.7% of non-nephrologists agreed that a kidney biopsy was required at the time of diagnosis, compared with 81.4% of nephrologists. Thirty-eight of 70 respondents (54.3%) reported measuring globotriaosylsphingosine (lyso-Gb3) as a biomarker. The most common period to measure lyso-Gb3 was at the time of diagnosis, followed by after ERT, before ERT, and at screening. For the stage at which ERT should begin, microalbuminuria and proteinuria were chosen by 51.8% and 28.6% of respondents, respectively. Conclusion: Nephrologists are more likely to treat variant Fabry disease rather than classic cases, and they agree that ERT should be initiated early in Fabry nephropathy, using lyso-Gb3 as a biomarker.

Simultaneous Determination of Four Compounds from Cercidiphyllum japonicum Using HPLC-UV Analysis

Cercidiphyllum japonicum is being used for the treatment of obesity and liver fibrosis in Korean local clinics. In the present study, we tried to develop an analytical methodology for the determination of the chemical markers of Cercidiphyllum japonicum. Four chemicals, maltol (1), chlorogenic acid (2), quercetin (3), and avicularin (4), were selected for method validation, and the analytical conditions were optimized and validated using high-performance liquid chromatography coupled with an ultraviolet detector (HPLC-UV). Additionally, the seasonal variations of four markers were monitored every month for six months. The contents of four chemicals markers were most detected in a sample collected in June.

Copeptin with high-sensitivity troponin at presentation is not inferior to serial troponin measurements for ruling out acute myocardial infarction

Objective@#We aimed to compare the multi-marker strategy (copeptin and high-sensitivity cardiac troponin I [hs-cTnI]) with serial hs-cTnI measurements to rule out acute myocardial infarction (AMI) in patients with chest pain. @*Methods@#This prospective observational study was performed in a single emergency department. To test the non-inferiority margin of 4% in terms of negative predictive value (NPV) between the multi-marker strategy (0 hour) and serial hs-cTnI measurements (0 and 2 hours), 262 participants were required. Samples for copeptin and hs-cTnI assays were collected at presentation (0 hour) and after 2 hours. The measured biomarkers were considered abnormal when hs-cTnI was >26.2 ng/L and when copeptin was >10 pmol/L. @*Results@#AMI was diagnosed in 28 patients (10.7%). The NPV of the multi-marker strategy was 100% (160/160; 95% confidence interval [CI], 97.7% to 100%), which was not inferior to that of serial hs-cTnI measurements (201/201; 100%; 95% CI, 98.2% to 100%). The sensitivity, specificity, and positive predictive value of the multi-marker strategy were 100% (95% CI, 87.7% to 100%), 68.1% (95% CI, 61.7% to 74.0%), and 27.2% (95% CI, 18.9% to 36.8%), respectively. The sensitivity, specificity, and positive predictive value of serial hs-cTnI measurements were 100% (95% CI, 87.7% to 100%), 85.5% (95% CI, 80.4% to 89.8%), and 45.2% (95% CI, 32.5% to 58.3%), respectively. @*Conclusion@#The multi-marker strategy (copeptin and hs-cTnI measurement) was not inferior to serial hs-cTnI measurements in terms of NPV for AMI diagnosis, with a sensitivity and NPV of 100%. Copeptin may help in the early rule-out of AMI in patients with chest pain.

Efficacy of low-dose spironolactone on top of angiotensin receptor blockade in patients with glomerulonephritis

BACKGROUND: Previous studies have shown that aldosterone antagonists have a proteinuria-lowering effect in patients with proteinuria and progressive proteinuric disease not adequately controlled by the use of angiotensin receptor blockers (ARBs). Aldosterone antagonists, in combination with ARBs, might improve proteinuria in patients with glomerulonephritis (GN). METHODS: In the present retrospective study, we evaluated the proteinuria-lowering effect and drug safety of low-dose spironolactone (12.5 mg/day) in 42 patients with GN being treated with an ARB. RESULTS: Proteinuria decreased from a mean total-protein-to-creatinine (TP/Cr) ratio of 592.3 ± 42.0 mg/g at baseline to 335.6 ± 43.3 mg/g after three months of treatment with spironolactone (P < 0.001). After the initial three months, the mean TP/Cr ratio increased progressively at six, nine, and 12 months; however, it was still less than the baseline value (P = 0.001, < 0.001, and < 0.001, respectively). Although serum Cr levels increased significantly at three and nine months compared with baseline (P = 0.036 and 0.026, respectively), there was no time effect of treatment (P = 0.071). Serum potassium levels tended to increase with time (P = 0.118), whereas systolic and diastolic blood pressures decreased with time (P = 0.122 and 0.044, respectively). CONCLUSION: Low-dose spironolactone in combination with an ARB reduced proteinuria in patients with GN, which could represent a novel treatment option in individuals whose proteinuria is not optimally controlled by the use of ARBs alone.

Associations Between Serum Vitamin D Level and Skeletal Complications in Multiple Myeloma Patients

OBJECTIVE: Vitamin D deficiency can either cause or aggravate osteopenia and osteoporosis, and that can lead to an increased risk of fracture. We studied associations between serum vitamin D level and skeletal complications including bone pain in multiple myeloma patients. METHODS: This study reviewed the medical records of 35 multiple myeloma patients in Soonchunhyang University Bucheon Hospital from January, 2013 to May, 2014. The patients were classified as three groups according to the total vitamin D level: above 20 ng/mL as sufficient group, from 10 to 20 ng/mL as insufficient group, and below 10 ng/mL as deficient group. RESULTS: The incidence of fracture complication, the number of fracture, and the number of the cases of severe fracture that needed surgical intervention did not show statically significant difference in the three groups according to the total vitamin D level. As the results presented as graphs, the number of indicator of skeletal complications and total vitamin D level showed negative relationship. In the logistic regression analysis, analgesic use due to bone pain and the number of total analgesic use were significantly different in three groups (P=0.036, P=0.041), respectively, and showed a negative correlation between the level of vitamin D and number of analgesics had negative correlation. CONCLUSION: The measurement of serum total vitamin D level at the initial diagnosis in multiple myeloma patients and the proper treatment in the deficient patients would reduce the skeletal complications and moreover improve the quality of life.

Does anti-thymocyte globulin have a place in busulfan/fludarabine conditioning for matched related donor hematopoietic stem cell transplantation?

BACKGROUND/AIMS: There is controversy about the prophylactic effect of anti-thymocyte globulin (ATG) on graft versus host disease (GVHD) in the setting of matched related-donor hematopoietic stem cell transplantation (HSCT). This study assessed the inf luences of ATG on the incidences of acute and chronic GVHD and other clinical outcomes in matched related-donor HSCT. METHODS: Sixty-one patients received allogeneic HSCT from human leukocyte antigen-matched, related donors. Patients received busulfan/fludarabine conditioning regimens and standard GVHD prophylaxis with or without additional ATG. RESULTS: There was no significant difference in the cumulative incidences of overall acute GVHD, grade II to IV acute GVHD at day 100, and chronic GVHD during the follow-up period between the ATG and non-ATG groups. Three-year overall survival rates were very similar, but three year disease-free survival of the non-ATG group was higher than that of the ATG group (56.2% for ATG vs. 63.1% for non-ATG, p = 0.597). Relapse rate at 3 years in the ATG group was slightly higher than that of the non-ATG group (37.5% vs. 20%, p = 0.29). Non-relapse mortality rate at 3 years was lower in the ATG group (6.25% vs. 15.6%, p = 0.668). CONCLUSIONS: Although the addition of ATG doesn't guarantee a reduction in the incidences of acute and chronic GVHD, pre-transplantation ATG may result in lower non-relapse mortality in the context of matched related-donor HSCT with a busulfan/fludarabine conditioning regimen. However, caution is needed when using ATG because of a possibility to increase relapse rate.

Development and Implementation of Emergency Department based Heat related Illness Active Surveillance System: Effect of Heat Index on Daily Emergency Department Visits due to Heat related Illness

PURPOSE: To evaluate the effect of heat wave on emergency department (ED) visits due to heat related illness, we developed an ED based active surveillance system. We want to identify epidemiology of ED visits due to heat related illness and determine the effect of heat index on daily ED visits due to heat related illness. METHODS: We developed an ED based active surveillance system for adults who visited the ED due to heat stroke, heat exhaustion, heat syncope, heat edema, and heat cramp. We collected demographic and clinical variables, risk factors, and heat index by standardized registry on the webpage. We operated the surveillance into 16 emergency departments in Daegu City from June to September 2011. We analyzed epidemiologic variables descriptively and assessed the effect of heat index on the number of daily ED visits by multivariate Poisson regression analysis. RESULTS: During the study period, 34 cases were registered and nine cases were heat stroke. Heat stroke patients were older, and had more unemployment status than those with other heat related illness (p<0.05). More ED visits due to heat related illness were observed during the danger period than during the cool period, classified by heat index severity (Adjusted odds ratio: 1.72, 95% CI: 1.33-2.23). Increasing heat index by one degree caused more ED visits due to heat related illness (Adjusted incident rate ratio: 1.13, 95% CI: 1.07-1.19). CONCLUSION: We developed an ED based active surveillance system and observed more elderly persons and lower educational level in patients with heat stroke. In addition, increase in heat index significantly affected more daily ED visits due to heat related illness.

The effects of pycnogenol on antioxidant enzymes in a mouse model of ozone exposure

BACKGROUND/AIMS: Ozone is an environmentally reactive oxidant, and pycnogenol is a mixture of flavonoid compounds extracted from pine tree bark that have antioxidant activity. We investigated the effects of pycnogenol on reactive nitrogen species, antioxidant responses, and airway responsiveness in BALB/c mice exposed to ozone. METHODS: Antioxidant levels were determined using high performance liquid chromatography with electrochemical detection. Nitric oxide (NO) metabolites in bronchoalveolar lavage (BAL) fluid from BALB/c mice in filtered air and 2 ppm ozone with pycnogenol pretreatment before ozone exposure (n = 6) were quantified colorimetrically using the Griess reaction. RESULTS: Uric acid and ascorbic acid concentrations were significantly higher in BAL fluid following pretreatment with pycnogenol, whereas gamma-tocopherol concentrations were higher in the ozone exposed group but were similar in the ozone and pycnogenol pretreatment groups. Retinol and gamma-tocopherol concentrations tended to increase in the ozone exposure group but were similar in the ozone and pycnogenol pretreatment groups following ozone exposure. Malonylaldehyde concentrations increased in the ozone exposure group but were similar in the ozone and pycnogenol plus ozone groups. The nitrite and total NO metabolite concentrations in BAL fluid, which parallel the in vivo generation of NO in the airways, were significantly greater in the ozone exposed group than the group exposed to filtered air, but decreased with pycnogenol pretreatment. CONCLUSIONS: Pycnogenol may increase levels of antioxidant enzymes and decrease levels of nitrogen species, suggesting that antioxidants minimize the effects of acute ozone exposure via a protective mechanism.

The Establishment of Dendritic Cell-Tumor Fusion Vaccines for Hormone Refractory Prostate Cancer Cell

PURPOSE: Dendritic cell (DC)-based tumor vaccine is an attractive modality for the treatment of hormone-refractory prostate cancer (HRPC) because it has some efficacy and few side effects in patients with poor general conditions. The aim of this study was to establish which is the most effective DC vaccine for the treatment of HRPC. We compared DC vaccine sensitized with tumor lysate and a fusion vaccine of DCs and tumor cells. MATERIALS AND METHODS: The DU145 cancer cell line was purchased from the American Type Culture Collection. DCs were cultured from peripheral blood monocytes. Peripheral blood monocytes were cultured in RPMI 1640 medium supplemented with interleukin-4 (IL-4), granulocyte-macrophage colony-stimulating factor, and 10% fetal calf serum. Tumor necrosis factor-alpha was added on day 7 to support maturation. Functional activity was measured in three groups: the DC single-culture group, the DC culture group with DC vaccine sensitized with tumor lysates, and the DC culture group prepared with tumor fusion vaccine made from irradiated tumor cells and monocyte-derived DCs by the polyethylene glycol method. RESULTS: By FACS analysis, the rate of DC-tumor fusion vaccine was 20.3+/-3%. The IL-12 level produced by the DC-tumor fusion vaccine was significantly higher than that of DCs pulsed with tumor lysate (p<0.05). Also, the generation of interferon-gamma by tumor-specific T cells in the DC-tumor fusion vaccine group was superior to that of DCs pulsed with tumor lysate (p<0.05). In addition, the T cells of the tumor lysate-pulsed DCs and tumor fusion vaccine had 1.6 and 2.5 times the functional activity, respectively, of the DC single-culture group in killing tumor cells in the cytotoxicity assay. CONCLUSIONS: The DC-tumor fusion vaccine seems to be more effective than DC single-culture or DC-tumor lysate vaccine in the treatment of HRPC.

Postpartum Emphysematous Cystitis after Casarean Section

Emphysematous cystitis is a rare infectious condition of the urinary bladder. Underlying diabetes mellitus is present in over half of reported cases with women being affected twice as often as men. It also occurs in alcoholism, undernutrition, radiating and immunosuppressive treatments. We present a case of postpartum emphysematous cystitis after Casarean section (C-sec) in a young female without underlying disease.

Preliminary Report on a Modified Surgical Technique Using Canal Transobturator Tape for the Treatment of Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Canal transobturator tape(TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling(DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT. MATERIALS AND METHODS: Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7(IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes. RESULTS: The mean operative time for Canal TOT was 22.4 minutes(range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency(n=3), weak stream(n=4) and difficult emptying(n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair(n=7), rectocele repair(n=5), rectocele and cystocele repair(n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy(n=1). The average follow-up was 4.5 months(range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence. CONCLUSIONS: Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate.

Malignant Prostatic Hemangiopericytoma / 대한비뇨기과학회지

Hemangiopericytoma is a relatively uncommon vascular tumor. It was first described by Stout and Murray in 1942. Here, we report a case of a primary prostatic hemangiopericytoma, which has been reported approximately <10 cases. This may be the first case of a prostatic hemangiopericytoma in Korea. A 35-year-old male patient presented with an episode of dysuria and perineal discomfort over the past 3 months. The radiological and histological features indicated a malignant hemangiopericytoma. Systemic chemotherapy was selected as the primary treatment. After 5 cycles of chemotherapy, the size of masses of the prostate and lung decreased. Four months after then, the patient died from hemoptysis.

Malignant Prostatic Hemangiopericytoma / 대한비뇨기과학회지

Hemangiopericytoma is a relatively uncommon vascular tumor. It was first described by Stout and Murray in 1942. Here, we report a case of a primary prostatic hemangiopericytoma, which has been reported approximately <10 cases. This may be the first case of a prostatic hemangiopericytoma in Korea. A 35-year-old male patient presented with an episode of dysuria and perineal discomfort over the past 3 months. The radiological and histological features indicated a malignant hemangiopericytoma. Systemic chemotherapy was selected as the primary treatment. After 5 cycles of chemotherapy, the size of masses of the prostate and lung decreased. Four months after then, the patient died from hemoptysis.

Staged Transurethral Resection of Prostate for Large Benign Prostatic Hyperplasia: A Comparative Study with Open Prostatectomy / 대한비뇨기과학회지

PURPOSE: Although open prostatectomy is usually considered when the prostate gland is greater than 50cc, it needs an incision and relatively longer hospital days and has a potential for intraoperative hemorrhage. For these reasons, we performed staged transurethral resection of the prostate (TURP) consecutively instead of open prostatectomy for benign prostatic hyperplasia (BPH) patient with a prostate larger than 50cc. MATERIALS AND METHODS: Among total 30 BPH patients with a prostate larger than 50cc in volume, 14 patients underwent immediate repeat TURPs (group A) and 16 patients underwent suprapubic prostatectomies (group B). Preoperative international prostate symptom score (IPSS), uroflowmetry, pressure-flow study, operative data, postoperative immobilization period because of hematuria and other complications were reviewed. IPSS and uroflowmetry were followed up to 6 months after operation. RESULTS: There were no statistically significant differences in age, preoperative IPSS and Qmax between the two groups. At 6 months after the operation mean Qmax and IPSS were improved in both groups significantly, and while Qmax was higher in the group B, there was no significant difference in decreasing IPSS. In the group A, hospital stay and immobilization period were shorter and there was no patient who needed transfusion because of bleeding or suffered from TUR symdrome. In contrast, 9 (75%) patients needed transfusion because of bleeding in the group B. CONCLUSIONS: Staged TURP is a valuable surgical method with respect to absence of incision, effective symptom improvement, short hospital stay and postoperative immobilization perod and low risk of complications such as bleeding and TUR syndrome in symptomatic BPH patient who has a prostate volume over 50cc.

The Role of Partial Cystectomy for Transitional Cell Carcinoma of the Urinary Bladder / 대한비뇨기과학회지

No abstract available.

Complete Androgen Insensivity Syndrome in Sisters / 대한비뇨기과학회지

No abstract available.

2 Cases of Prostatic Myosarcoma : Rhabdomyosarcoma andn Leiomyosarcoma / 대한비뇨기과학회지

No abstract available.

The Correlation between Ultrasonic Prameters of the Prostate and the Bladder Outlet Obstruction in BPH Patients / 대한비뇨기과학회지

No abstract available.

Urodynamic Predictive Factors for Surgical Treatment Outcome of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Transurethral prostatectomy(TURP) or open prostatectomy were considered as standard treatments for benign prostatic hyperplasia(BPH), but these treatments showed high morbidity and mortality. We searched urodynamic predictive factors for successful surgical outcome to select patients who would benefit from prostatectomy pre-operatively. MATERIALS AND METHODS: Retrospectively, we reviewed preoperative urodynamic findings of 114 patients with BPH undergoing TURP(104cases) or open prostatectomy(10cases). RESULTS: In the follow-up period of 1 month to 19 months, a strict successes were achieved in 83 patients(73%). On analysis of the success rate, 4 favorable urodynamic factors and 8 unfavorable urodynamic factors were noted. 4 favorable factors were as follows; maximal flow rate6cm and presence of peak elevation on prostatic urethra pressure. 8 unfavorable factors were as follow; intermittent or normal flow pattern, prostatic urethral length100cmH2O, prostatic pressure area <70cm cmH2O, non-obstructive pattern on Abrams-Griffiths nomogram and detrusor pressure at maximal flow rate <50cmH2O. CONCLUSIONS: Patients with more than 1 unfavorable urodynamic factor should be investigated carefully before surgery and be treated with other non-invasive treatment for BPH. The presence of 2 favorable urodynamic factors without unfavorable factor will usually predict the best surgical outcome.