Platelet Function and Genotype after DES Implantation in East Asian Patients: Rationale and Characteristics of the PTRG-DES Consortium

Purpose@#Platelet function test (PFT) results and genotype hold unique prognostic implications in East Asian patients. The aim of the PTRG-DES (Platelet function and genoType-Related long-term proGnosis in Drug-Eluting Stent-treated Patients with coronary artery disease) consortium is to assess the clinical impact thereof on long-term clinical outcomes in Korean patients with coronary artery disease during dual antiplatelet therapy (DAPT) including clopidogrel. @*Materials and Methods@#Searching publications on the PubMed, we reviewed clopidogrel treatment studies with PFT and/or genotype data for potential inclusion in this study. Lead investigators were invited to share PFT/genotype results, patient characteristics, and clinical outcomes to evaluate relationships among them. @*Results@#Nine registries from 32 academic centers participated in the PTRG-DES consortium, contributing individual patient data from 13160 patients who underwent DES implantation between July 2003 and August 2018. The PTRG-PFT cohort was composed of 11714 patients with available VerifyNow assay results. Platelet reactivity levels reached 218±79 P2Y12 reaction units (PRU), and high on-clopidogrel platelet reactivity based on a consensus-recommended cutoff (PRU >208) was observed in 55.9%. The PTRGGenotype cohort consisted of 8163 patients with candidate genotypes related with clopidogrel responsiveness. Of those with cytochrome P450 (CYP) 2C19 genotype, frequencies of carrying one and two loss-of-function allele (s) (*2 or *3) were 47.9% (intermediate metabolizers) and 14.2% (poor metabolizers), respectively. @*Conclusion@#The PTRG-DES consortium highlights unique values for on-clopidogrel platelet reactivity and CYP2C19 phenotype that may be important to developing optimal antiplatelet regimens in East Asian patients.

Human Papillomavirus Prevalence and Genotype Distribution among HIV-Infected Women in Korea

The epidemiology on human papillomavirus (HPV) among human immunodeficiency virus (HIV)-infected women in Korea is not well established. A retrospective study was conducted to determine the prevalence and genotype distribution of HPV infection among HIV-infected women in Korea. HPV DNA genotype and cervical cytology were examined in 60 HIV-positive women and 1,938 HIV-negative women. HPV genotypes were analyzed by using a HPV DNA chip. HIV-infected women had higher prevalence of high-risk HPV (hr-HPV) infection (30% vs 4.9%, adjusted odds ratio [AOR], 6.96; 95% confidence interval [CI], 3.63-13.34, P<0.001) and abnormal cervical cytology (18.3% vs 1.8%, AOR, 10.94; 95% CI, 5.18-23.1, P<0.001) compared with controls. The most common hr-HPV genotype detected in HIV-infected women was HPV 16 (10%), followed by 18 (6.7%) and 52 (5%). Prevalence of quadrivalent vaccine-preventable types (HPV 6, 11, 16, and 18) was 21.7% and 2.3% in HIV-positive women and HIV-negative women, respectively. Age was a significant risk factor for hr-HPV infection in HIV-infected women (P=0.039). The presence of hr-HPV was significantly associated with abnormal cervical cytology (P<0.001). These findings suggest that HPV testing for cervical cancer screening in HIV-infected women would be necessary, particularly among young age group.

Patients satisfaction for implant supported overdenture with small diameter implant / 대한치과보철학회지

PURPOSE: In cases when implant supported overdenture is made by using standard size implant, additional procedure such as bone surgery and bone grafting can be required. And it gives burden to doctor and patient in terms of cost. Therefore, it is necessary to find the implant therapy for the edentulous patients in making denture with accordable cost and simple procedure. MATERIALS AND METHODS: Edentulous patients with upper and lower dentures participated in this study. Before the operation, survey about patient's satisfaction to the existing dentures was carried out. Surgical procedures included four small diameter implants installation anterior area and immediate loading. One and three month after the procedure, the same survey about patient's satisfaction was carried out, and radiography was taken. RESULTS: We are doing research to the nine patients. Survival rate is 97.2 percent. The comparison of patient's satisfaction before and after surgery is performed based on oral health impact profile 49. We analyze mainly with masticatory discomfort, retention, aesthetics, social problem, psychological discomfort problems. As a result, satisfaction level is increased at all factors. Retention is the most increased satisfactory factor followed by mastication difficulty, pronunciation, psychological discomfort, social discomfort, aesthetics in order. Marginal bone loss is 0.21 mm at 12 weeks after implant placement. CONCLUSION: This research reveals that the denture supported by mini dental implant increases patient's satisfaction. This study will be continued with more patients for a long time and we are scheduled for taking additional radiography to check whether peri-implant bone resorption occurs or not.

What we learned from difficult hepatectomies in patients with advanced hepatic malignancy

BACKGROUNDS/AIMS: By reviewing difficult resections for advanced hepatic malignancies, we discuss the effectiveness and extended indications for hepatectomy in such patients. METHODS: We reviewed 7 patients who underwent extensive surgery between July 2008 and March 2011 for advanced hepatic malignancies. They had stage IV disease, except for in one case that was a stage IIIC (T4N0M0) hepatocellular carcinoma (HCC). RESULTS: Patient 1 with intrahepatic cholangiocarcinoma (IHCC) underwent right hemihepatectomy and resection of the bile duct and left portal vein. At 39 months after surgery, she had no recurrence or metastasis. Patient 2 with HCC underwent palliative right trisectionectomy. At 38 months after surgery, he is alive despite residual pulmonary metastases. Patient 3 with HCC invading the hepatic vein and diaphragm underwent right trisectionectomy and caval venoplasty. At 12 months after surgery, he had no recurrence or metastasis. Patient 4, who had 2 large HCCs and pulmonary thromboembolism, underwent a right trisectionectomy. At 7 months after surgery, he had no evidence of recurred HCC. Patient 5, who had IHCC invading her inferior vena cava and main portal vein, underwent preoperative radiotherapy, left hemihepatectomy, and caval resection. At 20 months after surgery, she is well despite a caval thrombus. Patient 6 and 7 underwent repeated surgery due to a recurred IHCC and metastatic colon cancer, respectively. In addition, they are alive during each 20 and 17 months after surgery. CONCLUSIONS: Despite macroscopic extrahepatic metastases or major vessel involvement, extensive surgery for advanced hepatic malignancy may result in relatively favorable outcomes and be important modality for improving of survival in such patients.

Outcomes of Hepatic Resection Using Intermittent Hepatic Vascular Inflow Occlusion with Low Central Venous Pressure / 한국간담췌외과학회지

PURPOSE: Blood loss and transfusions during a liver resection are associated with higher morbidity and mortality rates. With applying hepatic vascular inflow occlusion (Pringle maneuver), persistent bleeding during a hepatic transection is caused by back flow from the hepatic veins. Therefore, low central venous pressure facilitates to reduce-bleeding from the hepatic veins by lowering the back flow pressure gradient. An intermittent hepatic vascular inflow occlusion was applied, with a lowering of the central venous pressure, during a hepatic resection in our series of patient. The effect of these maneuvers in reducing bleeding and the postoperative complication rates were analyzed. METHODS: Between December 2000 and September 2003, in 153 hepatic resection patients, where this technique was used, the intermittent vascular inflow occlusion and maintenance of the central venous pressure as low as possible were accrued in this study. The overall outcomes of patients that had a hepatic resection, focusing on the amount of bleeding, blood product transfusion and complication rates, were analyzed. RESULTS: The median blood loss was 652.5 ml, and 111 patients (72.5%) required no perioperative blood transfusion. The median units of blood required in the patients who needed a transfusion were 2.3 U. There was no evidence of renal derangement related with low blood flow into the kidney by keeping central venous pressure as low as possible. There were minor complications in 34 patients (22.4%) and two in-hospital mortalities (1.3%) associated with hepatic failure in cirrhotics. CONCLUSION: A hepatic resection, with an intermittent Pringle maneuver and a low central venous pressure, is a very simple and effective modality to reduce bleeding during a hepatic transection, with low morbidity and mortality rates and without hepatic and renal dysfunctions.

The Changes of Serologic Markers in Pneumoconiosis of Coal Workers / 결핵

BACKGROUND: Pneumoconiosis is a parenchymal lung disease that results from the accumulation of coal dust in the lungs and the consequent tissue reaction. To evaluate the role of various personal factors in pneumoconosis and the significance of some serologic markers for assessing the disease activity related to pneumoconiosis, the Rheumatoid Factor(RF), α1-AT, C-Reactive Protein(CRT), ceruloplasmin and fibrinogen levels were measured. METHOD: All the patients were males, 45-76 years old, and the mean duration of coal dust exposure was 23.2 years. 51 patients were classified as having Simple Pneumoconiosis (SP), 59 had Progressive Massive Fibrosis (PMF). Fifty eight men with ages ranging from 26-70 years wer used as normal controls. The serum RF and CRT were titrated using an Autochemistry analyzer (HITACHI 7150 : Japan) and the α1-AT and ceruloplasmin levels were measured using a Nephelometer (Behring Nephelometer : Germany) and the fibrinogen levels were estimated by using and Autoanalyzer for hematologic coagulation. RESULT: There was a higher RF level in the SP, and PMF groups than in the control groups but there was no statistical difference. The CRP, α1-AT, and ceruloplasmin levels were also higher in the SP, and PMF groups. However, the fibrinogen concentration was within the normal ranges in both the SP and PMF groups. CONCLUSION: The CWP (Ed note : Define CWP) patients had significantly higher CRP, α1-AT, and ceruloplasmin levels compared to the control group. It is believed that these serologic changes could be used as a marker of the disease activity.

Function of the neuronal M2 muscarinic receptor in asthmatic patients / 결핵

BACKGROUND: The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to M3 muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal M2 muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these M2 muscarinic receptors act as autoreceptors. Loss of function of these M2 receptors, as it occres in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of M2 muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. METHODS: We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test(PC 20<16mg/ml). Methacholine provocation tests performed twice on separate days allowing for an interval of one week. In the second test, pre-treatment with the M2 muscarinic receptor agonist pilocarpine(180µg) through inhalation was performed before the routine procedures. RESULTS: Eleven subjects with mild asthma and eight aubjects with moderate asthma showed significant increase of PC20 from 5.30±5.23mg/ml(mean±SD) to 20.82±22.56mg/ml(p=0.004) and from 2.79±1.5mg/ml to 4.67±3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of PC20 from 1.76±1.50mg/ml to 3.18±4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. CONCLUSION: In subjects with mild and moderate asthma, function of M2 muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. These results suggest that function of M2 muscarinic receptors is different according to severity of asthma.