Two-year Clinical Outcomes of Patients with Long Segments Drug-Eluting Stents: Comparison of Sirolimus-Eluting Stent with Paclitaxel-Eluting Stent

Limited data are available on the long-term clinical efficacy of drug-eluting stent (DES) in diffuse long lesions. From May 2006 to May 2007, a total of 335 consecutive patients (374 lesions) were underwent percutaneous coronary intervention with implantation of long DES (> or = 30 mm) in real world practice. Eight-month angiographic outcomes and 2-yr clinical outcomes were compared between SES (n = 218) and PES (n = 117). Study endpoints were major adverse cardiac events including cardiac death, myocardial infarction, target-lesion revascularization, target-vessel revascularization and stent thrombosis. Baseline characteristics were similar in the two groups as were mean stent length (44.9 +/- 15.2 mm in SES and 47.4 +/- 15.9 in PES, P = 0.121). Late loss at 8 months follow-up was significantly lower in SES than in PES group (0.4 +/- 0.6 mm in SES vs 0.7 +/- 0.8 mm in PES, P = 0.007). Mean follow-up duration was 849 +/- 256 days, and 2-yr cumulative major adverse cardiac events were significantly lower in the SES than in the PES group (5.5% in SES vs 15.4% in PES, P = 0.003). In conclusion, long-term DES use in diffuse long coronary lesions is associated with favorable results, with SES being more effective and safer than PES in this real-world clinical experience.

Therapeutic Strategy for In-Stent Restenosis Based on the Restenosis Pattern After Drug-Eluting Stent Implantation

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the outcomes of repeated percutaneous coronary intervention (PCI) based on the restenosis pattern in drug-eluting stent (DES) failure. SUBJECTS AND METHODS: From April 2003 to March 2006, all 67 patients (67 lesions) at our 3 centers who had DES in-stent restenosis (ISR) were enrolled. The patients were divided into 3 groups: group I had focal edge restenosis, group II had focal body restenosis, and group III had non-focal restenosis. All patients were treated with conventional PCI including plain old balloon angioplasty (POBA), cutting balloon angioplasty (CBA), and repeated DES implantation (Re-DES). Angiographic and clinical one year follow-up results for the 3 groups were evaluated. RESULTS: Sixteen patients were enrolled in group I, 36 in group II, and 15 in group III. Baseline clinical and angiographic characteristics and the proportion of patients in each group receiving each type of treatment strategy were not significantly different among the groups. Within each group, a comparison of angiographic and clinical outcomes for each therapeutic modality revealed that restenosis rates were not statistically different. Although rates of major adverse cardiac events (MACE) were not statistically different between groups I and II, in group III, MACE were 3-fold higher for the POBA (4/4, 100.0%) and CBA (4/4, 100.0%) subgroups than for Re-DES (1/3, 33.3%) (p=0.06), but the differences did not reach statistical significance. CONCLUSION: The present study suggests that treatment of DES ISR should be individualized according to restenosis pattern: any PCI strategy appears appropriate for focal ISR patterns, while Re-DES might be a better choice for non-focal ISR patterns.

Risk Factors Associated with Hemodynamic Instability during Stent Implantation in Unprotected Left Main Lesions without Routine IABP: Identification of the High Risk Patients

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) stenosis is a promising approach during this era of drug-eluting stents. However, there is no available hemodynamic data on these type patients during the performance of LMCA stenting. The purpose of this study was to determine the risk factors affecting hemodynamic stability during LMCA stenting, and to evaluate whether hemodynamic support such as inotropics or intra-aortic balloon pump (IABP) is needed, based on the risk factors. SUBJECTS AND METHODS: From July 2003 to January 2006, we enrolled 92 study patients (Male=55) who had visited Yeungnam University Hospital, Keimyung University Dongsan Hospital and InJe University Baik Hospital in Busan and they were all were diagnosed with angiographically detected unprotected LMCA stenosis. Group 1 (n=69) included those patients who did not need hemodynamic support during PCI. Group 2 (n=23) included patients who needed hemodynamic support during PCI. All patients had stents deployed in the LMCA lesions without hemodynamic support; the clinical, angiographic and procedural outcomes were compared between the two groups after the procedure. RESULTS: The baseline patient characteristics were not statistically different between the two groups. On univariate analysis, Group 2 had more patients diagnosed with acute myocardial infarction (AMI) than Group 1 (40% vs. 15%, respectively, p=0.014). Group 1 had a greater frequency of an increased left ventricular (LV) ejection fraction than Group 2 (60+/-10 vs. 47+/-11, respectively, p=0.01). Regarding the lesion location in the LMCA, Group 2 had relatively more lesions at bifurcated locations than Group 1 (44% vs. 78%, respectively, p=0.004). Group 2 required more complex techniques to repair lesions, such as kissing or crush stenting, than did Group 1 (19% vs. 48%, respectively, p=0.006). Multivariate logistic regression analysis showed that the presence of AMI (Odds Ratio (OR)=3.74, p=0.014), a complex stenting procedure such as kissing or crushing (OR=3.99, p=0.006), a bifurcated lesion (OR=4.58, p=0.004) and poor LV function (OR=9.95, p=0.0001) were independent risk factors for hemodynamic instability during LMCA stenting. CONCLUSION: The most important risk factor for hemodynamic instability during LMCA stenting was LV function. Therefore, preparation for hemodynamic support, including IABP before the procedure, is necessary for the high risk patients.

Lesion Location: Its Impacts on the Procedural and Postprocedural Outcomes of Unprotected Left Main Coronary Stenting

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) stenosis is a promising technique in the drug-eluting stent era. However, there is a lack of data as to the impact of the lesion location in the LMCA on the procedural and postprocedural outcomes. The aim of this study is to evaluate the effect of lesion location on the procedural and postprocedural outcomes. SUBJECTS AND METHODS: From July 2003 to January 2006, we enrolled 82 patients (Males: n=49), who underwent PCI for unprotected LMCA stenosis at Yeungnam University Medical Center, Keimyung University Dong-san Hospital and In-je University Baik Hospital in Busan. The patients were divided into two groups according to the lesion location. Group 1 (n=38) was defined as those patients who had a significant stenosis in the ostium and/or body. Group 2 (n=44) was defined as those patients had a left main coronary lesion involving a bifurcation. All the patients had a sirolimus eluting stent (Cypher, Cordis) deployed into the LMCA stenosis. Stenting techniques such as the T, crush and kissing stent techniques for treating the LMCA were used at the discretion of the operator and according to the characteristics of the lesion location. The in-hospital outcomes were compared between the two groups and follow-up coronary angiography was performed after 6 months; the major adverse cardiac events (MACE) and restenosis were analyzed between the two groups. RESULTS: The baseline characteristics between the two groups were not statistically different. The procedural outcomes showed that for the stenting methods, the conventional stent technique was the only one used in all cases of Group 1, but the kissing, T stenting and Crush techniques were also used in Group 2 (p=0.001). The clinical outcomes showed that that there was no statistical difference for the in-hospital MACEs between the two groups, but for the out-of hospital MACEs at 6 month, the target lesion revascularizatin rates, including PCI or bypass graft operation, in Group 1 were higher than those in Group 2 (0% vs 13.6%, respectively p=0.043). Both groups had one cardiac death each (2.3% vs 2.6% respectively) and there was 1 MACE in Group 1 and 7 MACEs in Group 2 (2.6% vs 16%, respectively, p=0.045). The angiographic outcomes at 6 month showed that all 8 significant restenosis cases were included in Group 2 (18%, 9.7% in the total population); the restenosis site was the left circumflex artery in all cases. CONCLUSION: PCI with using drug eluting stents in the left main lesion showed favorable short term outcomes in selected patients. The lesion location is also an important factor for the clinical and angiographical outcomes.

Relationship between duodenal ulcers and cagA, vacA, and iceA genotypes of Helicobacter pylori / 대한내과학회지

BACKGROUND: The aims of this study were to evaluate whether genotypes of Helicobacter pylori are different between the gastric antrum and duodenal bulb in order to assess the roles of duodenal H. pylori strains in development of duodenal ulcer. METHODS: Forty-eight H. pylori infected patients (duodenal ulcer 28, chronic gastritis 20) were included for the study. Biopsy specimens were taken separately from the antrum and duodenal bulb for the histologic examination and H. pylori culture. cagA, vacA, and iceA genotypes of H. pylori were examined by polymerase chain reaction and H. pylori DNA subtypes by random amplified polymorphic DNA (RAPD) fingerprinting. RESULTS: H. pylori genotypes were not significantly different between antrum and duodenal bulb of the duodenal ulcer and chronic gastritis. RAPD fingerprinting showed different H. pylori strains between the gastric antrum and duodenal bulb in 2 patients with duodenal ulcer. Most prevalent genotype was cagA+ vacA s1/m1 iceA1 in duodenal ulcer (15/16). CONCLUSION: The host factor or other genotypes may play the major roles in duodenal ulcerogenesis compared with H. pylori genotype itself.

Prophylactic Effect of Lactobacillus GG in Animal Colitis and Its Effect on Cytokine Secretion and Mucin Gene Expressions / 대한소화기학회지

BACKGROUND/AIMS: Lactobacillus rhamnosus GG (LGG) has been used in acute colitis treatment. However, it is unclear whether the LGG prevents chronic colitis. The aim of this study was to examine the prophylactic effect of LGG on animal colitis, cytokine secretion, and mucin gene expression. METHODS: BALB/c mice (n=64) were exposed to 5% dextran sulfate sodium (DSS) for 7 days followed by 10 days recovery period and repeatedly exposed for 4 days. Then, the mice were devided into three group; group of oral LGG adminstration throughout the recovery and repeated colitis period; PBS group of PBS administration; control group. Colon length, histologic score, tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10) levels, mucin gene expressions were determined at each period. RESULTS: In acute colitis period, the LGG group showed higher levels of disease activity index (DAI), histologic score, TNF-alpha, IL-10, but shorter colon length, lower levels of mucin gene expressions than the control group. However, in repeated colitis period, the LGG group showed markedly lower levels of DAI and IL-10 but significantly longer colon length than PBS group (p<0.05). There was no difference in the mucin gene expression. CONCLUSIONS: These results suggest that LGG prevents chronic murine colitis. It may be associated with cytokine modulation and competitive inhibition of pathogenic bacteria. However, it may not be related with gene expression.

Measurement of Telomerase Activity and Telomerase Reverse Transcriptase Expression in Gastric Fluid and Tissue for Early Diagnosis of Stomach Cancer / 대한소화기학회지

BACKGROUND/AIMS: Telomerase activity and telomerase reverse transcriptase (TERT) expression have been proposed as a marker for malignancy. However, little is known about those markers in intestinal metaplasia (IM). This study was performed to evaluate the usefulness of telomerase activity in gastric washing fluid and TERT expression in tissue as a marker for early diagnosis of stomach cancer. METHODS: Gastric washing fluid and biopsies were taken endoscopically. We examined the telomerase activity by telomeric repeat amplification protocol (TRAP) and the TERT expression by semiquantitative reverse transcription-polymerase chain reaction in 26, 21 and 15 cases of cancer, IM, and normal mucosa respectively. RESULTS: The telomerase activity was positive in 65% of cancer, 44% of incomplete IM, and 33% of complete IM. The TERT was expressed in 89% of cancer, 81% of IM, but not in normal mucosa. The TERT expression level was higher in cancer and incomplete IM than in complete IM and normal mucosa (p<0.05). CONCLUSIONS: Telomerase activity in gastric washing fluid and TERT expression in tissue may have limited usefulness as a marker for the early diagnosis of stomach cancer. However, the increased levels of TERT expression in IM and cancer suggest that TERT expression may be associated with carcinogenesis in stomach cancer.

The Analysis of Emergency Department Costs

PURPOSE: To report the distribution of emergency department costs by category of expense and level of patient urgency. METHODS: We retrospectively analyzed the cases of 36,329 patients who visited the emergency department of Pundang CHA hospital during the recent 1year. the patients were divided into two groups : urgent group and non urgent group. Physician, facility, supply, pharmacy, laboratory, and radiology costs were considered. RESULTS: The average costs were urgent visits, 96,124 won; nonurgent visits, 87,028 won. For all patients, the average costs were radiology, 29%; facility, 26%; laboratory, 21%; physician, 12%; pharmacy, 8%; supply, 4%. CONCLUSION: The distribution of ED costs were similiar to regardless of the urgency of the medical condition. Overall improved cost efficiency can be achieved through reductions in the Variable costs of ED.

Study of Adult Stroke Patients and Improvement in Activities of Daily Living from Time of Stroke to Two Months Thereafter

BACKGROUNDS: A stroke is a disease of the nervous system which is accompanied by important chronic disabilities and emotional disorders. These disabilities causes loss of sensation(diminished basic movement). METHODS: Sensation rehabilitation therapy through Activities of Daily Living(ADL) Training is necessary. Reports show that patients who receive occupational therapy in the early stages have an extremely high rate of recovery in the early stages. It is important for a occupational therapist to provide continued reha- bilitative treatment to, enable the patient to accomplish Activities of Daily Living Training independently by treating everything from sustaining posture in bed to normal movement and improvement in sensory perception. occupational therapy refers to the `use of self` of a occupational therapist to help the patient overcome difficulties and increase abilities of the patients by applying knowledge, skill, care and basic patient merits. RESULTS: A occupational therapist must have the basic knowledge, self-confidence and individual skills for a systematic program of therapy in order to be able to communicate with the patient and increase the effectiveness of the therapy. CONCLUSION: This study showed that therapy for patients who received therapy soon after diagnosis of stroke showed to be greatly effective. A deeper study must be done in order to increase effectiveness of occupational therapy methods such as the NDT(treatment to improve normal movement sensation) and SI method(treatment to increase sensitivity of perceptive movement and to give the ability to position objects according to shape and location).

A Case of Aortic Dissection with Compromised Superior Mesenteric Artery Treated with Stents Insertion at Origin of the Artery

The treatment of a thoracic aortic dissection is guided by prognostic and anatomical information. Stanford type A aortic dissection requires surgery, but the appropriate treatment of a Stanford type B aortic dissection has not been determined, especially in patients with visceral artery compromise associated with the aortic dissection due to the failure of surgery to improve the prognosis.We report a case of a 35-year-old man, with a Stanford type B aortic dissection, where the superior mesenteric artery was obstructed. This condition was successfully treated with stents inserted at the origin of the artery.

The Increased Expression of Chemokines in the Colonic Mucosa of Patients with Ulcerative Colitis

PURPOSE: To better understand the extent to which chemokines participate in the mucosal inflammatory response in patients with ulcerative colitis (UC), we assessed the expression of an array of chemokines in the colonic mucosa of UC patients. METHODS: Colonic mucosal biopsy specimens were obtained from 15 patients with UC and 12 normal controls. Messenger RNA (mRNA) levels for 10 chemokines were quantitated by reverse-transcription PCR using synthetic standard RNAs. The biopsy specimens were also cultured, and secreted chemokines in culture supernatants were assayed by ELISA. RESULTS: The mRNA expression of C-X-C (IL-8, GROalpha, GRObeta, GROgamma, ENA-78, and IP-10) and C-C (MCP-1, MIP-1beta, and RANTES), but not C (lymphotactin) chemokines was significantly higher in the affected mucosa of UC patients than in the unaffected mucosa of UC patients or in the normal mucosa of normal controls. The degree of increased expression was more prominent in the C-X-C than in the C-C chemokines. Further, the secretion of IL-8, GROalpha, ENA-78, and MCP-1 was higher in UC patients than in normal controls. Secretions of MIP-1beta and RANTES also showed a trend toward an increase in UC, but it did not reach statistical significance. CONCLUSION: The increased expression of a variety of chemokines in UC suggest that chemokines may play an important role in the immunopathogenesis of UC.

Growth Status, Calcium Regulating Hormones and Bone Mineral Density in Children with Intractable Epilepsy / 대한소아내분비학회지

PURPOSE: Abnormalities in calcium(Ca), vitamin D and bone mineral density (BMD) associated with antiepileptic drug(AED) are reported, but the results are inconsistent. In case of intractable epilepsy, poor growth and altered bone mineral metabolism may be prominent, possibly related to previous long-term use of multiple AED and poor activity. The aim of this study was to assess growth status, concentrations of calcium regulating hormones and BMD in children with intractable epilepsy. METHODS: Sixty-six intractable epilepsy patients aged 0.8 to 14.7 years(mean+/-D:4.6+/-.6 years) were included in the study. Height and weight were measured and then height SDS and weight SDS were calculated. Serum Ca, i-Ca, P, Mg, Zinc, osteocalcin, intact-PTH, 25-OHD, 1,25(OH)2D were measured. BMD of the lumbar spine was measured by dual energy X-ray absorption. RESULTS: Most of the patients showed normal height SDS and weight SDS. Percentage of severe short stature(height SDS 2) was 4.5%. Percentage of severe thin(weight SDS 2) was 6%. Duration of AED was not related to height SDS or weight SDS. Etiology of epilepsy and physical activity were not related to height SDS and weight SDS. Most of them had normal Ca, iCa, P, Mg, Zinc, intact-PTH, osteocalcin, 25-OHD and 1,25(OH)2D concentrations. BMD was not related to the levels of Ca, i-Ca, P, Mg, intact-PTH, osteocalcin, 25-OHD, 1,25(OH)2D. BMD was not related to the duration of AED. BMD positively correlated with age(r=0.75, P>0.01) and body weight(r=0.72, P<0.01). CONCLUSION: Most of the children with intractable epilepsy, who regularly visits epilepsy clinic, showed normal growth and normal bone mineral metabolism, but careful monitoring about growth and bone mineral metabolism is needed.

A Case of Cerebral Thromboembolism Occurred after Restoration to Sinus Rhythm of Paroxysmal Atrial Flutter in Apical Hypertropic Cardiomyopathy with Spontaneous Echo Contrast(SEC)

Atrial flutter occurs most often in patients with organic heart disease. It appears that chronic atrial flutter is associated with a remarkably high risk of clinically apparent thromboembolism and effective anticoagulation appears to reduce this risk, but acute or recent onset, postoperative atrial flutter may have a lower risk of thromboembolism than those with chronic atrial flutter. In chronic atrial flutter or fibrillation with organic heart disease, anticoagulation is generally justified but there is some debate about anticoagulation in paroxysmal atrial flutter. The spontaneous echo contrast is generally accepted one of the major risk factor of thromboembolism and usually occurred in mitral stenosis, dilated cardiomyopathy, and enlarged left atrium, but rarely observed in apical hypertrophic cardiomyopathy. We experienced a patient with apical hypertrophic cardiomyopathy, who visited to emergency medical center due to dizziness and suffered from cerebral thromboembolism after restoration of sinus rhythm. In transesophageal echocardiography, there was moderate to severe spontaneous echo contrast in left atrium. This patient showed that transesophageal echocardiography evaluation of left atrium might be mandatory in patients with paroxysmal atrial flutter and organic heart disease.

A Case of Vasospastic Angina Pectoris Occurring Following Administration of Oral Imigran(R) for Migraine

Imigran(R) (sumatriptan), a 5-hydroxytryptamine (HT) derivative, is highly effective in aborting attacks of migraine and cluster headache. The drug is generally well tolerated. However tolerated, although up to 8% of patients consistently have demonstrate chest symptoms, including chest pressure, tightness, and pain, often mimicking angina pectoris. It has been suggested that these chest symptoms are caused by coronary vasoconstriction, and that this effect may be mediated by endothelial dysfunction. This can be reversed by the administration of glyceryl trinitrate. We report a case of vasospastic angina pectoris occurring after the administration of oral sumatriptan in a patient with migraine.

Usefulness of Resistive Index and Pulsatility Index in Patient with Diabetic Nephropathy as Early Markers / 대한신장학회잡지

BACKGROUND: Diabetic nephropathy has long been known as most common culprit of ESRD. In NIDDM, histopathologically intrarenal hemodynamic changes are nonspecific, frequently with global glomerulosclerosis, interstitial fibrosis, tubular atrophy and severe arterosclerosis. Duplex renal Doppler sonography is useful in the noninvasive assessment of intrarenal hemodynamic change and Doppler indices reflect increased renal vascular resistance. So we compared the values of R.I. and P.I., in NIDDM patients, with several clinical parameters to identify that R.I. and P.I. values can reflect increased renal vascular resistance and predict diabetic nephropathy as early markers. METHODS: Renal Doppler US scan was performed on 40 patients with NIDDM to obtain Doppler signals from arcuate artery or interlobar artery and thereby calculate the R.I. and P.I. From every each individual, clinical and laboratory data including age, sex, morbidity period, BMI, mean blood pressure, total cholesterol, serum creatinine, BUN, HbA1c, 24 hr urine protein and creatinine clearance were analyzed. We analyzed the correlation between values of R.I. and P.I. with clinical parameters by using univariate and multiple linear regression analysis. The patients were classified as three groups on the basis of the amount of 24 hour urine protein and value of serum creatinine : Group 1(n=15) was defined as patients with 24 hr urine protein less than 150mg/day and serum creatinine less than 1.5mg/ dL, group 2(n=12) as between 150mg/day and 500mg/ day and serum creatinine less than 1.5mg/dL and group 3(n=13) as more than 500mg/day or serum creatinine above 1.5mg/dL. RESULTS: 1) R.I. values showed correlation with age, morbidity period, mean blood pressure, HbA1c, serum creatinine, BUN, creatinine clearance and 24 hour urine total protein. P.I. values showed correlation with age, morbidity period, mean blood pressure, serum creatinine, BUN, creatinine clearance and 24 hour urine total protein. 2) R.I. and P.I. values were significantly affected by creatinine clearance and age in multiple regression analysis. 3) There were statistically positive correlation between 24 hour urine protein and R.I. and P.I.. But when we divided into three groups based on their amount of 24 hour urine protein. R.I. didn't show statistical correlation but P.I. showed significant correlation in the group of patients with proteinuria over 500mg/day(p<0.05). CONCLUSION: Renal doppler indices reflect increased renal vascular resistance in NIDDM patients and correlate with clinical parameters of diabetic nephropathy. We suggest that the R.I. and P.I. are useful marker for indicating diabetic vascular complication in NIDDM patients. However, further comparative studies should be carried out to elucidate the usefulness of R.I. and P.I. as early markers or advantaging parameters in predicting diabetic nephropathy.

Macrovascular dysfunction detected by comparison of serum FDP detected by simplified venous occlusion test in patients with NIDDM and CVA / 대한내과학회지

OBJECTIVES: In diabetic patients, the incidence of atherosclerotic disease are increased, which may be due to decreased fibrinolytic activity. The aim of study is to elucidate the relationship between angiopathies and vascular function evaluated by simplified venous occlusion test in patients with non-insulin dependent diabetes mellitus (NIDDM) and cerebrovascular accident (CVA). METHODS: The study was conducted on 63 patients who were hospitalized during the period from March 1, 1994 to May 30, 1997. The serum concentration of fibrinogen degradation products (FDP) was measured before and 5 min after venous occlusion in 31 NIDDM patients, 16 CVA patients and 16 age-matched control subjects. FDP was measured with the anti-fibrinogen- coated latex particle agglutinin assay system. RESULTS: 1) The basal serum FDP level was higher in diabetic patients with macroangiopathy (12.3+/-5.8 ug/ml) and patients with CVA (11.2+/-5.1 ug/ml) than in control subjects (5.7+/-1.8 ug/ml) (p<0.05). 2) The increment of serum FDP level after venous occlusion in diabetic patients with microangiopathy (6.6+/-2.2 to 10.3+/-4.1 ug/ml) and control subjects (5.7+/-1.8 to 11.4+/-4.3 ug/ml) was significantly higher than basal serum FDP level (p<0.05). But the increment of serum FDP level after venous occlusion in diabetic patients with macroangiopathy (12.3+/-5.8 to 15.2+/-5.1 ug/ml) and patients with CVA (11.2+/-5.1 to 13.7+/-4.8 ug/ml) wasn't significantly higher than basal serum FDP level. 3) The increment rate of serum FDP after venous occlusion in diabetic patients with macroangiopathy (24.4+/-29.3%) and patients with CVA (29.4+/-34.5%) was significantly lower than diabetic patients with microangiopathy (66.3+/-71.7%) and control subjects (84.1+/-69.3%) (p<0.05). CONCLUSION: The responsiveness of fibrinolytic activity to venous occlusion was significantly lower in diabetic patients with macroangiopathy, as in patients with CVA, compared with that in control subjects. We conclude that measurement of the increase in serum FDP concentration 5 min after venous occlusion may be useful to detect vascular dysfunction in patients with macrovascular disease caused by atherosclerosis.

Comparison of Pulsed-field Gel Electrophoresis, Amplified Fragment Length Polymorphism, and Infrequent Restriction Site-Polymerase Chain Reaction for Molecular Typing of Escherichia coli and Staphylococcus aureus Strains / 감염

BACKGROUND: Pulsed-field gel electrophoresis (PFGE) has been regarded a standard method for genotyping in epidemiologic studies. However, it is tedious and time-consuming to perform. Two alternative genotyping methods have recently been developed using the polymerase chain reaction (PCR):amplified fragment length polymorphism (AFLP) and infrequent restriction site-polymerase chain reaction (IRS-PCR). These methods have not yet been applied yet to common pathogens such as Staphylococcus aureus. The purpose of this study was to determine the applicability of AFLP and IRS-PCR for the genotyping of E. coli and S. aureus isolates. METHODS: We performed PFGE, AFLP, and IRS-PCR on clinical isolates of E. coli (n=27) and S. aureus (n=30). We assessed each method in terms of discriminatory power, quality, and efficiency. RESULTS: In E. coli, the discriminatory powers of IRS-PCR and AFLP were comparable to that of PFGE. PFGE discerned 24 (88.8%) out of 27 strains, IRS-PCR discerned 22 (81.5%) out of 27, and AFLP discerned 25 (92.6%) out of 27. In the case of S. aureus, PFGE discerned 27 (90%) out of 30 strains, while both IRA-PCR and AFLP discerned 12 (40%) out of 30. The test-ing took four days to complete with PFGE, two days with AFLP, and was completed within one day with IRS-PCR. IRS-PCR showed better resolution than both PFGE and AFLP. CONCLUSION: In cases of E. coli, AFLP and IRS-PCR could be good alternatives for epidemiologic typing, as they offer better efficiency and comparable discriminatory power to PFGE. On the other hand, IRS-PCR and AFLP do not seem to be suitable for the strain-to-strain differentiation of S. aureus.

The Effect of Epidermal Growth Factor on the Preimplantation Development, Implantation and Its Receptor Expression in Mouse Embryos / 대한산부인과학회잡지

This study was performed to investigate the influence of epidermal growth factor (EGF) on preimplantation development, implantation, and expression of epidermal growth factor receptor (EGFR) in mouse embryos. Riverse transcription-polymerase chain reaction (RT-PCR) has been used to examine the presence of transcripts. Following reverse transcription, strategically designed nested primers, optimised for specificity, were used for amplification from the cDNA equivalent of a single embryo. The products were then verified by restriction enzyme digestion and sequence analysis. Eight-cell stage mouse embryos were cultured for 48hrs with EGF at concentrations of 0.1, 1.0, 10 and 100 ng/ml. Embryos not treated with EGF were served as control. The percentages of embryos which developed to the expanded, hatched blastocyst stage and in vitro implantation at 48hrs were determined. The percentages of fully expanded murine blastocysts at 48hrs in all EGF treated group were not significantly different from the control. The percentages of hatched blastocysts were significantly higher in EGF treatment group at 0.1ng/ml (90.7%), 10 ng/ml (89.3%) compared to the control (82.1%; p < 0.05, p < 0.05). The percentages of implanted blastocyst in vitro were significantly higher following incubation with EGF at concentrations of O.lng/ml (38.1%; p < 0.05), 1.0ng/ml (33.3%; p < 0.05), 10ng/ml (22.2%; p < 0.05) compared to the control (10.7%). Embryo development and implantation in vitro were not significantly inhibited or enhanced in cultures supplemented with 100ng/ml EGF compared to the control. The mRNA concentration of EGFR in embryos treated with 0.1ng/ml of EGF were significantly higher than those of the control and other EGF treatment groups. The implantation rate and mRNA concentration of EGFR in embryos treated with 0.1ng/ml of EGF group were significantly higher than those of other treatd groups. In conclusion, EGF may have a stimulatory role in embryonic development, implantation and expression of EGFR in embryo itself with concentration-specific manner. These results suggest that EGF may act directly on the mouse embryo and favor its implantaion, irtespective of the presence ar absence of the endometrium.

Molecular analysis of fluoroquinolone-resistance in Escherichia coli on the aspect of gyrase and multiple antibiotic resistance (mar) genes

We analyzed the fluoroquinolone resistance mechanism of 28 isolates of ciprofloxacin-resistant E. coli from patients who received ciprofloxacin as a regimen of a selective gut decontamination. Isolates distinctive by infrequent restriction site polymerase chain reaction (IRS-PCR) were subjected to Hinf I restriction fragment length polymorphism analysis, single-stranded conformation polymorphism (SSCP), and nucleotide sequencing of the quinolone resistance determining region (QRDR) in gyrA. Double mutations in QRDR of gyrA (Ser83 Leu and Asp87Asn) were found from most of the strains. Nucleotide sequencing of the marR locus showed that 18 out of 28 (64%) ciprofloxacin-resistant E. coli strains had three types of base change in marR loci: a double-base change at nucleotides 1628 and 1751, or 1629 and 1751: and a single-base change at 1751. However, all the mutated strains showed no tolerance to cyclohexane test, suggesting the mutation in the marR region had no influence on overexpression of the MarA protein. In conclusion, mutation in gyrA was the main mechanism of ciporfloxacin resistance in E. coli from patients with selective gut decontamination. Therefore, mutation in the mar region did not influence the levels of ciprofloxacin resistance in our isolates.

Clinical Study of the Intravenous Amiodarone in Acute Myocardial Infarction with Life-Threatening Refractory Ventricular Tachyarrhythmias

BACKGROUND: Recently, the amiodarone has emerged as a promising antiarrhythmic agent and its efficacy and safety has been widely accepted with many literatures. But there was no general agreement regarding the dosage and indication of intravenous (IV) amiodarone in acute myocardial infarction with life-threatening refractory ventricular tachyarrhythmias. METHOD: From October 1995 through October 1997, we recruited retrospectively 9 patients of acute myocardial infarction who had received IV amiodarone for life-threatening refractory ventricular tachyarrhythmias and analyzed the initial response, adverse effect, and loading dose. RESULTS: 1) Acute efficacy:Eight of 9 patients promptly restored normal sinus rhythm immediately after intravenous amiodarone administration. 2) In-Hospital Mortality:One patients died due to ventricular tachyarrhythmias refractory to aggressive management and 5 in 8 patients who had responded promptly with IV amiodarone discharged alive and other 3 patients died due to cardiogenic shock with normal sinus rhythm. 3) Immediate adverse effects:Five patients experienced immediate adverse effects after IV amiodarone; 3 patients of hypotension, 1 patient of first degree AV block, and the other of Morbitz type 2 AV block. 4) Long term follow-up:Among 5 patients discharged alive, one died as unexpected consequence. Other 4 patients have been still alive without maintenance medication. CONCLUSION: The IV amiodarone for suppression of life-threatening ventricular tachyarrhythmias in patients with acute myocardial infarction seemed to be an effective second-line therapeutic drug and have acceptable adverse effects. In the future, the large scale study regarding the dosage and indication might be warrented.