Diagnostic Role of Bile Pigment Components in Biliary Tract Cancer

Bile pigment, bilirubin, and biliverdin concentrations may change as a results of biliary tract cancer (BTC) altering the mechanisms of radical oxidation and heme breakdown. We explored whether changes in bile pigment components could help distinguish BTC from benign biliary illness by evaluating alterations in patients with BTC. We collected bile fluid from 15 patients with a common bile duct stone (CBD group) and 63 individuals with BTC (BTC group). We examined the bile fluid’s bilirubin, biliverdin reductase (BVR), heme oxygenase (HO-1), and bacterial taxonomic abundance. Serum bilirubin levels had no impact on the amounts of bile HO-1, BVR, or bilirubin. In comparison to the control group, the BTC group had considerably higher amounts of HO-1, BVR, and bilirubin in the bile. The areas under the curve for the receiver operating characteristic curve analyses of the BVR and HO-1 were 0.832 (p<0.001) and 0.891 (p<0.001), respectively. Firmicutes was the most prevalent phylum in both CBD and BTC, according to a taxonomic abundance analysis, however the Firmicutes/Bacteroidetes ratio was substantially greater in the BTC group than in the CBD group. The findings of this study showed that, regardless of the existence of obstructive jaundice, biliary carcinogenesis impacts heme degradation and bile pigmentation, and that the bile pigment components HO-1, BVR, and bilirubin in bile fluid have a diagnostic significance in BTC. In tissue biopsies for the diagnosis of BTC, particularly for distinguishing BTC from benign biliary strictures, bile pigment components can be used as additional biomarkers.

Long-Term Efficacy of Prophylactic Cavotricuspid Isthmus Ablation during Atrial Fibrillation Ablation in Patients Without Typical Atrial Flutter: a Prospective, Multicentre, Randomized Trial

Background and Objectives@#Cavotricuspid isthmus (CTI) block is easily achieved, and prophylactic ablation can be performed during atrial fibrillation (AF) ablation. However, the previous study was too small and short-term to clarify the efficacy of this block. @*Methods@#Patients who underwent catheter ablation for paroxysmal AF were enrolled, and patients who had previous or induced atrial flutter (AFL) were excluded. We randomly assigned 366 patients to pulmonary vein isolation (PVI) only and prophylactic CTI ablation (PVI vs. PVI+CTI). @*Results@#There was no significant difference in procedure time between the two groups because most CTI blocks were performed during the waiting time after the PVI (176.8±72.6 minutes in PVI vs. 174.2±76.5 minutes in PVI+CTI, p=0.75). All patients were followed up for at least 18 months, and the median follow-up was 3.4 years. The recurrence rate of AF or AFL was not different in the 2 groups (25.7% in PVI vs. 25.7% in PVI+CTI, p=0.92). The recurrence rate of any AFL was not significantly different in the 2 groups (3.3% in PVI vs. 1.6% in PVI+CTI, p=0.31). The recurrence rate of typical AFL also was not different (0.5% in PVI vs. 0.5% in PVI+CTI, p=0.99). @*Conclusions@#In this large and long-term follow-up study, prophylactic CTI ablation had no benefit in patients with paroxysmal AF without typical AFL.

Circulating microRNAs as biomarkers in bile-derived exosomes of cholangiocarcinoma

Purpose@#In this pilot study, using next-generation sequencing and integrated messenger RNA (mRNA) sequencing, we investigated circulating microRNA (miRNA) expression profiling from bile-derived exosomes to identify dysregulated miRNA signatures and oncogenic pathways and determine their effects on targeted mRNAs in cholangiocarcinoma (CCA).Moreover, we explored the possibility that genetic analysis using bile-derived exosomes may replace gene analysis using tissue. @*Methods@#Bile was collected from a patient with perihilar CCA before curative resection. As a control, bile was collected from a patient with a common bile duct stone. Exosomes were isolated from the bile, and we performed next-generation miRNA sequencing using isolated exosomes. To evaluate miRNA-mRNA interactions, mRNA sequencing was performed using bile fluid in both patients. @*Results@#We identified 22 differentially expressed miRNAs. More than 65% of the predicted mRNA targets of those miRNAs were actually differentially expressed between control and CCA bile samples. In functional pathway analysis, targets of 22 miRNAs were primarily enriched in mitogen-activated protein kinase, platelet derived growth factor, vascular endothelial growth factor, epidermal growth factor receptor, and p53 signaling. In particular, in the functional assessment of miRNAmRNA interactions, RAS pathways, including downstream pathways (PI3K-AKT-mTOR and RAS-RAF-MEK-ERK), were determined to be enriched. @*Conclusion@#Circulating miRNAs in bile-derived exosomes provide new information for the development of miRNA analysis in CCA. These miRNAs may represent the oncogenic characteristics of CCA tissue, enabling them to be used instead of tissue samples for the diagnosis of CCA. Further research investigating circulating miRNAs in bile exosomes may lead to more rational, targeted approaches to treatment.

Long-Term Efficacy of Prophylactic Cavotricuspid Isthmus Ablation during Atrial Fibrillation Ablation in Patients Without Typical Atrial Flutter: a Prospective, Multicentre, Randomized Trial

Background and Objectives@#Cavotricuspid isthmus (CTI) block is easily achieved, and prophylactic ablation can be performed during atrial fibrillation (AF) ablation. However, the previous study was too small and short-term to clarify the efficacy of this block. @*Methods@#Patients who underwent catheter ablation for paroxysmal AF were enrolled, and patients who had previous or induced atrial flutter (AFL) were excluded. We randomly assigned 366 patients to pulmonary vein isolation (PVI) only and prophylactic CTI ablation (PVI vs. PVI+CTI). @*Results@#There was no significant difference in procedure time between the two groups because most CTI blocks were performed during the waiting time after the PVI (176.8±72.6 minutes in PVI vs. 174.2±76.5 minutes in PVI+CTI, p=0.75). All patients were followed up for at least 18 months, and the median follow-up was 3.4 years. The recurrence rate of AF or AFL was not different in the 2 groups (25.7% in PVI vs. 25.7% in PVI+CTI, p=0.92). The recurrence rate of any AFL was not significantly different in the 2 groups (3.3% in PVI vs. 1.6% in PVI+CTI, p=0.31). The recurrence rate of typical AFL also was not different (0.5% in PVI vs. 0.5% in PVI+CTI, p=0.99). @*Conclusions@#In this large and long-term follow-up study, prophylactic CTI ablation had no benefit in patients with paroxysmal AF without typical AFL.

Circulating microRNAs as biomarkers in bile-derived exosomes of cholangiocarcinoma

Purpose@#In this pilot study, using next-generation sequencing and integrated messenger RNA (mRNA) sequencing, we investigated circulating microRNA (miRNA) expression profiling from bile-derived exosomes to identify dysregulated miRNA signatures and oncogenic pathways and determine their effects on targeted mRNAs in cholangiocarcinoma (CCA).Moreover, we explored the possibility that genetic analysis using bile-derived exosomes may replace gene analysis using tissue. @*Methods@#Bile was collected from a patient with perihilar CCA before curative resection. As a control, bile was collected from a patient with a common bile duct stone. Exosomes were isolated from the bile, and we performed next-generation miRNA sequencing using isolated exosomes. To evaluate miRNA-mRNA interactions, mRNA sequencing was performed using bile fluid in both patients. @*Results@#We identified 22 differentially expressed miRNAs. More than 65% of the predicted mRNA targets of those miRNAs were actually differentially expressed between control and CCA bile samples. In functional pathway analysis, targets of 22 miRNAs were primarily enriched in mitogen-activated protein kinase, platelet derived growth factor, vascular endothelial growth factor, epidermal growth factor receptor, and p53 signaling. In particular, in the functional assessment of miRNAmRNA interactions, RAS pathways, including downstream pathways (PI3K-AKT-mTOR and RAS-RAF-MEK-ERK), were determined to be enriched. @*Conclusion@#Circulating miRNAs in bile-derived exosomes provide new information for the development of miRNA analysis in CCA. These miRNAs may represent the oncogenic characteristics of CCA tissue, enabling them to be used instead of tissue samples for the diagnosis of CCA. Further research investigating circulating miRNAs in bile exosomes may lead to more rational, targeted approaches to treatment.

A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation

Background and Objectives@#The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established. The standard approach to RFCA in AF is pulmonary vein isolation (PVI). However, a large proportion of patients experiences recurrence of atrial tachyarrhythmia. The purpose of this study is to find out whether the AI model can assess AF recurrence in patients who underwent PVI. @*Materials and methods@#This study was a retrospective cohort study that enrolled consecutive patients who under‑ went catheter ablation for symptomatic, drug-refractory AF and PVI. We developed an AI algorithm to predict recur‑ rence of AF after PVI using patient demographics and three-dimensional (3D) reconstructed left atrium (LA) images. @*Results@#We included 527 consecutive patients in the study. The overall mean LA diameter was 42.0 ± 6.8 mm, and the mean LA volume calculated using 3D reconstructed images was 151.1 ± 46.7 ml. During the follow-up period, atrial tachyarrhythmia recurred in 158 patients. The area under the curve (AUC) of the AI model based on a convolu‑ tional neural network (including 3D reconstruction images) was 0.61 (95% confidence interval [CI] 0.53–0.74) using the test dataset. The total test accuracy was 66.3% (57.0–75.6), and the sensitivity was 53.3% (34.8–71.9). The specificity was 73.2% (51.8–75.0), and the F1 score was 52.5% 34.5–66.7). @*Conclusion@#In this study, we developed an AI algorithm to predict recurrence of AF after catheter ablation of PVI using individual reconstructed LA images. This AI model was unable to predict recurrence of AF overwhelmingly;therefore, further large-scale study is needed.

A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation

Background and Objectives@#The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established. The standard approach to RFCA in AF is pulmonary vein isolation (PVI). However, a large proportion of patients experiences recurrence of atrial tachyarrhythmia. The purpose of this study is to find out whether the AI model can assess AF recurrence in patients who underwent PVI. @*Materials and methods@#This study was a retrospective cohort study that enrolled consecutive patients who under‑ went catheter ablation for symptomatic, drug-refractory AF and PVI. We developed an AI algorithm to predict recur‑ rence of AF after PVI using patient demographics and three-dimensional (3D) reconstructed left atrium (LA) images. @*Results@#We included 527 consecutive patients in the study. The overall mean LA diameter was 42.0 ± 6.8 mm, and the mean LA volume calculated using 3D reconstructed images was 151.1 ± 46.7 ml. During the follow-up period, atrial tachyarrhythmia recurred in 158 patients. The area under the curve (AUC) of the AI model based on a convolu‑ tional neural network (including 3D reconstruction images) was 0.61 (95% confidence interval [CI] 0.53–0.74) using the test dataset. The total test accuracy was 66.3% (57.0–75.6), and the sensitivity was 53.3% (34.8–71.9). The specificity was 73.2% (51.8–75.0), and the F1 score was 52.5% 34.5–66.7). @*Conclusion@#In this study, we developed an AI algorithm to predict recurrence of AF after catheter ablation of PVI using individual reconstructed LA images. This AI model was unable to predict recurrence of AF overwhelmingly;therefore, further large-scale study is needed.

Genetic features associated with ¹⁸F-FDG uptake in intrahepatic cholangiocarcinoma

PURPOSE: In intrahepatic cholangiocarcinoma (iCCA), genetic characteristics on ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG)-PET scans are not yet clarified. If specific genetic characteristics were found to be related to FDG uptake in iCCA, we can predict molecular features based on the FDG uptake patterns and to distinguish different types of treatments. In this purpose, we analyzed RNA sequencing in iCCA patients to evaluate gene expression signatures associated with FDG uptake patterns. METHODS: We performed RNA sequencing of 22 cases iCCA who underwent preoperative ¹⁸F-FDG-PET, and analyzed the clinical and molecular features according to the maximum standard uptake value (SUVmax). Genes and biological pathway which are associated with SUVmax were analyzed. RESULTS: Patients with SUVmax higher than 9.0 (n = 9) had poorer disease-free survival than those with lower SUVmax (n = 13, P = 0.035). Genes related to glycolysis and gluconeogenesis, phosphorylation and cell cycle were significantly correlated with SUVmax (r ≥ 0.5). RRM2, which is related to the toxicity of Gemcitabine was positively correlated with SUVmax, and SLC27A2 which is associated with Cisplastin response was negatively correlated with SUVmax. According to the pathway analysis, cell cycle, cell division, hypoxia, inflammatory, and metabolism-related pathways were enriched in high SUVmax patients. CONCLUSION: The genomic features of gene expression and pathways can be predicted by FDG uptake features in iCCA. Patients with high FDG uptake have enriched cell cycle, metabolism and hypoxic pathways, which may lead to a more rational targeted treatment approach.

The optimal surgical resection approach for T2 gallbladder carcinoma: evaluating the role of surgical extent according to the tumor location

PURPOSE: The clinical behavior of T2 gallbladder cancer varies among patients. The aims of this study were to identify prognostic factors for survival and recurrence, and to determine the optimal surgical strategy for T2 gallbladder cancer. METHODS: We conducted a retrospective analysis of 78 patients with T2 gallbladder cancer who underwent surgical resection for gallbladder cancer. RESULTS: Twenty-eight patients (35.9%) underwent simple cholecystectomy and 50 (64.1%) underwent extended cholecystectomy. Among 56 patients without LN metastasis (n = 20) or unknown LN status (no LN dissection, n = 36), the 5-year disease-free survival rates were 81.6%, and 69.8% (P = 0.080). In an analysis according to tumor location, patients with tumors located on the hepatic side (n = 36) had a higher recurrence rate than patients with tumors located on the peritoneal side only (n = 35) (P = 0.043). On multivariate analysis, R1 resection and lymph node metastasis were significant, independent prognostic factors for poor disease-free and overall survival. CONCLUSION: R0 resection and LN dissection are an appropriate curative surgical strategy in patients with T2 gallbladder cancer. Tumors located on the hepatic side show worse prognosis than tumors located on the peritoneal side only, hepatic resection should be considered.

Recurrent fetal postpartum stress induced cardiomyopathy after normal vaginal delivery / 고신대학교의과대학학술지

Stress induced cardiomyopathy is a disease that shows a dysfunction of the ventricle, but it can be rapidly reversible. It often occurs in older women primarily who suffers from emotional or physical stress. There are some case reports about postpartum stress induced cardiomyopathy. Most of the patients are recovered naturally within days to weeks. We report a case of a 37 years-old woman, who had experienced postpartum stress induced cardiomyopathy 8 years ago, revisited hospital because of cardiomyopathy after secondary delivery. Herein we report a rare case of recurrent stress induced cardiomyopathy after secondary normal vaginal delivery.

Detailed Electrode Catheter Positioning is Important for the Ablation of Outflow Tract Origin Ventricular Arrhythmias

BACKGROUND AND OBJECTIVES: Electroanatomical mapping using a three-dimensional (3D) system has high accuracy and improves the results of the ablation of outflow tract (OT) premature ventricular contraction (PVC) or ventricular tachycardia (VT) but imposes a considerable economic burden. Here, we compared detailed diagnostic catheterization and 3D mapping system for the ablation of OT PVC/VT. MATERIALS AND METHODS: Between June 2012 and February 2017, patients with symptomatic OT PVC/VT underwent radiofrequency ablation. Group 1 underwent detailed diagnostic catheterization (using circular and linear multielectrodes) without a 3D mapping system, while group 2 underwent diagnostic catheterization using a conventional 3D mapping system. Procedural success of PVC reduction, remaining symptoms, need for post-operative medications, and procedural time were evaluated. RESULTS: Ninety-eight OT PVC/VT cases were consecutively enrolled. The mean follow-up period was 17.7±14.5 months. Neither acute success rate (95% vs. 82%, p=0.06) nor a PVC reduction > 80% (84% vs. 87%, p=0.74) differed significantly between the two groups. The recurrence rates of PVC-related symptoms were similar (12% vs. 7%, p=0.06) between the groups, but the medication requirement for symptomatic PVC differed (12% vs. 29%, p < 0.01). The total procedure time of group 1 was shorter than that of group 2 (132±42 min vs. 157±47 min, p=0.01) and fluoroscopy time (24±15 min vs. 38±22 min, p < 0.01) and ablation time (528±538 sec vs. 899±598 sec, p < 0.01) were also significantly shortened. CONCLUSION: Detailed electrode catheter positioning is a safe and cost-effective method for the ablation of OT PVC/VT.

Single Center Experiences of Conversion from Twice-daily Tacrolimus (Prograf) to Once-daily Tacrolimus (Advagraf) in Stable Liver Transplant Recipients / 대한이식학회지

BACKGROUND: Patient adherence to immunosuppressant regimens after organ transplant is crucial to preserve graft function, and simplifying the regimen improves adherence. In this study, our experience of conversion from twice-daily (b.i.d.) to once-daily (q.d.) tacrolimus (TAC) in stable liver transplant recipients is reviewed and the proper conversion regimen is investigated. METHODS: Between November 2011 and August 2012, the regimen was converted in 32 stable liver transplant recipients, and data on the conversions gathered retrospectively from medical records. TAC trough level, dose, and laboratory findings were evaluated at preconversion and 1 to 12 months after conversion. RESULTS: Conversion from b.i.d. to q.d. regimen was based on 1:1 proportion in 16 patients and dose escalation in 16 patients. The mean conversion time after transplant was 56.8 months (range; 21~94). Reconversion to b.i.d. regimen was needed in nine patients. Among these patients, seven patients needed titration due to elevated liver enzyme. The trough level decreased significantly after conversion (from 4.7 to 3.1 ng/mL) in patients with conversion at 1:1 proportion, while increasing slightly without statistical significance (3.7 to 4.0 ng/mL) in patients with dose escalation. At 1 year after conversion, dose adjustment was required to preserve trough level and graft function in 14 patients. CONCLUSIONS: Based on our results, TAC q.d. formulation can be a useful option to improve adherence in stable liver transplant recipients. However, dose titration should be considered for preserving proper trough level in case of low TAC level or TAC single regimen.

Single center experiences of needle-scopic grasper assisted single incision laparoscopic cholecystectomy for gallbladder benign disease: comparison with conventional 3-port laparoscopic cholecystectomy

PURPOSE: Single incision laparoscopic cholecystectomy (SILC) has some technical problems. Our group has performed needlescopic grasper assisted SILC (nSILC) to overcome these problems. In this study, we introduce our technique and evaluate the safety and feasibility of this technique compared with the conventional laparoscopic cholecystectomy (CLC). METHODS: The medical records of 485 patients who received nSILC and CLC were reviewed retrospectively. Surgical outcomes including operative time, hospital stay, postoperative pain and perioperative complication were compared between the 2 techniques. RESULTS: Although wound complications were developed more frequently in nSILC group, there was no significant difference between groups in other surgical outcomes. In subgroup analysis, surgical outcomes of nSILC were similar with those of CLC not only in easy group but also in difficult group. CONCLUSION: It seems that nSILC is safe and feasible not only in selected patients but also in difficult cases such as acute cholecystitis.

Visualization of the Critical Isthmus by Tracking Delayed Potential in Edited Windows for Scar-Related Ventricular Tachycardia

BACKGROUND AND OBJECTIVES: Identifying the critical isthmus of slow conduction is crucial for successful treatment of scar-related ventricular tachycardia. Current 3D mapping is not designed for tracking the critical isthmus and may lead to a risk of extensive ablation. We edited the algorithm to track the delayed potential in order to visualize the isthmus and compared the edited map with a conventional map. SUBJECTS AND METHODS: We marked every point that showed delayed potential with blue color. After substrate mapping, we edited to reset the annotation from true ventricular potential to delayed potential and then changed the window of interest from the conventional zone (early, 50-60%; late, 40-50% from peak of QRS) to the edited zone (early, 80-90%; late, 10-20%) for every blue point. Finally, we compared the propagation maps before and after editing. RESULTS: We analyzed five scar-related ventricular tachycardia cases. In the propagation maps, the resetting map showed the critical isthmus and entrance and exit sites of tachycardia that showed figure 8 reentry. However, conventional maps only showed the earliest ventricular activation sites and searched for focal tachycardia. All of the tachycardia cases were terminated by ablating the area around the isthmus. CONCLUSION: Identifying the channel and direction of the critical isthmus by a new editing method to track delayed potential is essential in scar-related tachycardia.

Changes in Atrioventricular Node Physiology Following Slow Pathway Modification in Patients with AV Nodal Re-entrant Tachycardia: The Hypothetical Suggestion of Mechanism of Noninducibility of AVNRT

BACKGROUND AND OBJECTIVES: In cases of radiofrequency catheter ablation (RFCA) for patients with atrioventricular nodal re-entrant tachycardia (AVNRT), complete elimination of slow pathway is not always achievable. Furthermore, in situations of the so-called modified slow pathway, the underlying mechanism of tachycardia elimination remains unclear. SUBJECTS AND METHODS: Patients who underwent RFCA for AVNRT, and showed persistence of dual atrioventricular nodal physiology but no induction of AVNRT after ablation were enrolled. We measured electrophysiologic parameters before and after the ablation procedure. RESULTS: The study subjects included 31 patients (39% men; mean age 43±19 years). The RR interval, Wenckebach cycle length of AV node, slow pathway effective refractory period, maximal AH interval of fast pathway and slow pathway showed no significant changes before and after ablation. However, fast pathway effective refractory period (360±67 vs. 304±55, p<0.001) and differences between slow pathway effective refractory period and fast pathway effective refractory period (90±49 vs. 66±35, p=0.009) were decreased after slow pathway ablation. CONCLUSION: We suggest a possible relationship between the mechanism of tachycardia elimination in AVNRT and an alteration of the re-entrant circuit by removal of the atrial tissue in Koch's triangle. This may be a critical component of providing the excitable gap for the maintenance of tachycardia rather than the electrical damage of slow pathway itself.

Prognostic factors after hepatic resection for the single hepatocellular carcinoma larger than 5 cm

PURPOSE: This study aimed to determine which factors affect the prognosis of hepatectomy for hepatocellular carcinoma (HCC) larger than 5 cm, including the prognostic difference between tumor sizes from 5–10 cm and larger than 10 cm. METHODS: The medical records of 114 patients who underwent hepatectomy for single HCC larger than 5 cm were reviewed and analyzed retrospectively. RESULTS: In the analysis of the entire cohort of 114 patients, the 5-year overall and diseases-free survival rates were 50% and 29%, respectively. In a comparison of survival rates between groups, tumor sizes of 5 to 10 cm and larger than 10 cm, the overall and disease-free survival rates were not significantly different, respectively (54% vs. 41%, P = 0.433 and 33% vs. 23%, P = 0.083). On multivariate analysis, positive hepatitis B, high prothrombin induced by vitamin K absence or antagonist-II levels over 200 mIU/mL, and vascular invasion (micro- and macrovascular invasion) were independent prognostic factors for recurrence after hepatic resection. However, tumor size larger than 10 cm was not significant for recurrence after resection. CONCLUSION: This study shows that surgical resection of solitary HCC larger than 5 cm showed favorable overall survival. And there is no survival difference with tumors between 5–10 cm and larger than 10 cm.

Prognostic factors after hepatic resection for the single hepatocellular carcinoma larger than 5 cm

PURPOSE: This study aimed to determine which factors affect the prognosis of hepatectomy for hepatocellular carcinoma (HCC) larger than 5 cm, including the prognostic difference between tumor sizes from 5–10 cm and larger than 10 cm. METHODS: The medical records of 114 patients who underwent hepatectomy for single HCC larger than 5 cm were reviewed and analyzed retrospectively. RESULTS: In the analysis of the entire cohort of 114 patients, the 5-year overall and diseases-free survival rates were 50% and 29%, respectively. In a comparison of survival rates between groups, tumor sizes of 5 to 10 cm and larger than 10 cm, the overall and disease-free survival rates were not significantly different, respectively (54% vs. 41%, P = 0.433 and 33% vs. 23%, P = 0.083). On multivariate analysis, positive hepatitis B, high prothrombin induced by vitamin K absence or antagonist-II levels over 200 mIU/mL, and vascular invasion (micro- and macrovascular invasion) were independent prognostic factors for recurrence after hepatic resection. However, tumor size larger than 10 cm was not significant for recurrence after resection. CONCLUSION: This study shows that surgical resection of solitary HCC larger than 5 cm showed favorable overall survival. And there is no survival difference with tumors between 5–10 cm and larger than 10 cm.

Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation

BACKGROUND AND OBJECTIVES: The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM. MATERIALS AND METHODS: Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation. RESULTS: Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality. CONCLUSION: Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.

The effect of glutathione S-transferase M1 and T1 polymorphisms on blood pressure, blood glucose, and lipid profiles following the supplementation of kale (Brassica oleracea acephala) juice in South Korean subclinical hypertensive patients

BACKGROUND/OBJECTIVES: Glutathione S-transferase (GST) forms a multigene family of phase II detoxification enzymes which are involved in the detoxification of reactive oxygen species. This study examines whether daily supplementation of kale juice can modulate blood pressure (BP), levels of lipid profiles, and blood glucose, and whether this modulation could be affected by the GSTM1 and GSTT1 polymorphisms. SUBJECTS/METHODS: 84 subclinical hypertensive patients showing systolic BP over 130 mmHg or diastolic BP over 85 mmHg received 300 ml/day of kale juice for 6 weeks, and blood samples were collected on 0-week and 6-week in order to evaluate plasma lipid profiles (total cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol) and blood glucose. RESULTS: Systolic and diastolic blood pressure was significantly decreased in all patients regardless of their GSTM1 or GSTT1 polymorphisms after kale juice supplementation. Blood glucose level was decreased only in the GSTM1-present genotype, and plasma lipid profiles showed no difference in both the GSTM1-null and GSTM1-present genotypes. In the case of GSTT1, on the other hand, plasma HDL-C was increased and LDL-C was decreased only in the GSTT1-present type, while blood glucose was decreased only in the GSTT1-null genotype. CONCLUSIONS: These findings suggest that the supplementation of kale juice affected blood pressure, lipid profiles, and blood glucose in subclinical hypertensive patients depending on their GST genetic polymorphisms, and the improvement of lipid profiles was mainly greater in the GSTT1-present genotype and the decrease of blood glucose was greater in the GSTM1-present or GSTT1-null genotypes.

Extended-Spectrum beta-Lactamase and Multidrug Resistance in Urinary Sepsis Patients Admitted to the Intensive Care Unit / 대한구급학회지

BACKGROUND: The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. METHODS: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. RESULTS: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. CONCLUSIONS: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.