Hybrid columellar strut using nasal crest bone of the maxilla and conchal cartilage for nasal tip stability in rhinoplasty for East Asian patients

Background@#Proper nasal tip projection and rotation are essential for an aesthetically pleasing nose. However, East Asians usually have thicker skin and underdeveloped nasal cartilage compared to Caucasians. Thus, techniques such as the septal extension graft, columellar strut graft, and L-shaped alloplastic implants have been introduced for additional nasal tip support and projection. However, no consensus exists regarding the optimal method. @*Methods@#A hybrid columellar strut made of an osteochondral graft recombined with the nasal crest of the maxilla and conchal cartilage was devised. In a cadaveric study, changes due to an external bending force of the hybrid strut and costal cartilage in the same dimension were measured. In a comparative study, we divided 20 subjects into two groups according to the material used for the columellar strut graft: a hybrid columellar strut (experimental group) and a double-layered conchal columellar strut (control group). Preoperative, 1-month postoperative, and 1-year postoperative anthropometric measurements were compared between groups. @*Results@#In the cadaveric study, the hybrid columellar strut showed superior mechanical strength. In the comparative study, the average 1-year postoperative change of the columellar labial angle was significantly smaller in the experimental group (–0.7°±1.16° vs. 2.2°±1.32°, P=0.015). The hybrid columellar strut showed superior postoperative nasal tip stability. @*Conclusions@#We devised a new hybrid columellar strut and confirmed its superior mechanical firmness and stability. Considering the suggested indications and contraindications, the hybrid columellar strut graft can be a new modality for tip plasty in East Asian rhinoplasty that can provide sufficient long-term nasal tip stability.

The Use of Phentermine for Obesity in Psychiatric Patients With Antipsychotics

Objective@#Phentermine is a commonly used weight-loss agent in the United States, but there is a little information about the use of phentermine for patients with obesity taking antipsychotic medications. @*Methods@#We gathered 57 patients with obesity taking antipsychotic medications whose phentermine treatment was simultaneous with or after any type of antipsychotic exposure and collected data of clinical information, initial/follow-up anthropometric variables, and adverse events (AEs) for the 6-month study period. @*Results@#In total, the mean body weight reduction (BWR) was 4.45 (7.04) kg, and the mean BWR percent (BWR%) was 3.92% (6.96%) at 6 months. Based on the response to phentermine, the patients were classified into two groups: the responder (n=25; BWR% ≥5%) and nonresponder (n=32; BWR% <5%) groups. The responder group’s mean BWR and BWR% were 10.13 (4.43) kg and 9.35% (4.09%), respectively, at 6 months. The responders had higher rates of anticonvulsant combination therapy (ACT; responder, 72.0% vs. non-responder, 43.8%; p=0.033) and a shorter total antipsychotic exposure duration (responder, 23.9 [16.9] months vs. non-responder, 37.2 [27.6] months; p= 0.039). After adjusting age, sex, and initial body weight, ACT maintained a significant association with phentermine response (odds ratio=3.840; 95% confidence interval: 1.082–13.630; p=0.037). In the final cohort, there was no report of adverse or new-onset psychotic symptoms, and the common AEs were sleep disturbances, dry mouth, and dizziness. @*Conclusion@#Overall, phentermine was effective and tolerable for patients with obesity taking antipsychotic medications, and ACT (predominantly topiramate) augmented the weight-loss effect of phentermine.

Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets

Background and Objectives@#This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). @*Methods@#A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). @*Results@#During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. @*Conclusion@#Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

Clinical features and predictors of masked uncontrolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

Background/Aims@#The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and proposed a prediction model for MUCH in patients with hypertension. @*Methods@#We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP. @*Results@#Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs compared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/m2 for men, and ≥ 96 g/m2 for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH. @*Conclusions@#MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.

Role of Autophagy in Granulocyte-Colony Stimulating Factor Induced Anti-Apoptotic Effects in Diabetic Cardiomyopathy

Background@#We previously, reported that granulocyte-colony stimulating factor (G-CSF) reduces cardiomyocyte apoptosis in diabetic cardiomyopathy. However, the underlying mechanisms are not yet fully understood. Therefore, we investigated whether the mechanisms underlying of the anti-apoptotic effects of G-CSF were associated with autophagy using a rat model of diabetic cardiomyopathy. @*Methods@#Diabetic cardiomyopathy was induced in rats through a high-fat diet combined with low-dose streptozotocin and the rats were then treated with G-CSF for 5 days. Rat H9c2 cardiac cells were cultured under high glucose conditions as an in vitro model of diabetic cardiomyopathy. The extent of apoptosis and protein levels related to autophagy (Beclin-1, microtubule-binding protein light chain 3 [LC3]-II/LC3-I ratio, and P62) were determined for both models. Autophagy determination was performed using an Autophagy Detection kit. @*Results@#G-CSF significantly reduced cardiomyocyte apoptosis in the diabetic myocardium in vivo and led to an increase in Beclin-1 level and the LC3-II/LC3-I ratio, and decreased P62 level. Similarly, G-CSF suppressed apoptosis, increased Beclin-1 level and LC3-II/LC3-I ratio, and decreased P62 level in high glucose-induced H9c2 cardiac cells in vitro. These effects of G-CSF were abrogated by 3-methyladenine, an autophagy inhibitor. In addition, G-CSF significantly increased autophagic flux in vitro. @*Conclusion@#Our results suggest that the anti-apoptotic effect of G-CSF might be significantly associated with the up-regulation of autophagy in diabetic cardiomyopathy.

Role of Autophagy in Granulocyte-Colony Stimulating Factor Induced Anti-Apoptotic Effects in Diabetic Cardiomyopathy

Background@#We previously, reported that granulocyte-colony stimulating factor (G-CSF) reduces cardiomyocyte apoptosis in diabetic cardiomyopathy. However, the underlying mechanisms are not yet fully understood. Therefore, we investigated whether the mechanisms underlying of the anti-apoptotic effects of G-CSF were associated with autophagy using a rat model of diabetic cardiomyopathy. @*Methods@#Diabetic cardiomyopathy was induced in rats through a high-fat diet combined with low-dose streptozotocin and the rats were then treated with G-CSF for 5 days. Rat H9c2 cardiac cells were cultured under high glucose conditions as an in vitro model of diabetic cardiomyopathy. The extent of apoptosis and protein levels related to autophagy (Beclin-1, microtubule-binding protein light chain 3 [LC3]-II/LC3-I ratio, and P62) were determined for both models. Autophagy determination was performed using an Autophagy Detection kit. @*Results@#G-CSF significantly reduced cardiomyocyte apoptosis in the diabetic myocardium in vivo and led to an increase in Beclin-1 level and the LC3-II/LC3-I ratio, and decreased P62 level. Similarly, G-CSF suppressed apoptosis, increased Beclin-1 level and LC3-II/LC3-I ratio, and decreased P62 level in high glucose-induced H9c2 cardiac cells in vitro. These effects of G-CSF were abrogated by 3-methyladenine, an autophagy inhibitor. In addition, G-CSF significantly increased autophagic flux in vitro. @*Conclusion@#Our results suggest that the anti-apoptotic effect of G-CSF might be significantly associated with the up-regulation of autophagy in diabetic cardiomyopathy.

Clinical features and predictors of masked uncontrolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

Background/Aims@#The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and proposed a prediction model for MUCH in patients with hypertension. @*Methods@#We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP. @*Results@#Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs compared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/m2 for men, and ≥ 96 g/m2 for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH. @*Conclusions@#MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.

Role of MicroRNA-34a in Anti-Apoptotic Effects of Granulocyte-Colony Stimulating Factor in Diabetic Cardiomyopathy

BACKGROUND: Recent studies have shown that microRNAs (miRNAs) are involved in the process of cardiomyocyte apoptosis. We have previously reported that granulocyte-colony stimulating factor (G-CSF) ameliorated diastolic dysfunction and attenuated cardiomyocyte apoptosis in a rat model of diabetic cardiomyopathy. In this study, we hypothesized a regulatory role of cardiac miRNAs in the mechanism of the anti-apoptotic effect of G-CSF in a diabetic cardiomyopathy rat model.METHODS: Rats were given a high-fat diet and low-dose streptozotocin injection and then randomly allocated to receive treatment with either G-CSF or saline. H9c2 rat cardiomyocytes were cultured under a high glucose (HG) condition to induce diabetic cardiomyopathy in vitro. We examined the extent of apoptosis, miRNA expression, and miRNA target genes in the myocardium and H9c2 cells.RESULTS: G-CSF treatment significantly decreased apoptosis and reduced miR-34a expression in diabetic myocardium and H9c2 cells under the HG condition. G-CSF treatment also significantly increased B-cell lymphoma 2 (Bcl-2) protein expression as a target for miR-34a. In addition, transfection with an miR-34a mimic significantly increased apoptosis and decreased Bcl-2 luciferase activity in H9c2 cells.CONCLUSION: Our results indicate that G-CSF might have an anti-apoptotic effect through down-regulation of miR-34a in a diabetic cardiomyopathy rat model.

Local Injection of Granulocyte-Colony Stimulating Factor Accelerates Wound Healing in a Rat Excisional Wound Model

A systemic treatment of granulocyte-colony stimulating factor (G-CSF) is known to improve healings of damaged tissues. However, recent studies suggested local actions of G-CSF on the healing processes of damaged tissues. We investigated the treatment effect of locally injected G-CSF and compared to that of systemically injected G-CSF in a rat model. A wound was created on the rat dorsum and treated either by local injection or by systemic injection of G-CSF. Wound healing rate, deposition of collagen, and gene expression were evaluated. G-CSF receptor (G-CSFR) protein was detected by Western blotting. The wound healing rate in the local injection group was significantly higher than that in the systemic injection group at days 9 and 15; it was also significantly higher than that in the control group at days 3, 9, and 15. The expression of G-CSFR protein in wound tissues was higher than in normal skin tissues. The local injection of G-CSF is more effective than systemic injection of G-CSF in promoting wound healing, which may implicate the local action of G-CSF treatment in wound healing processes.

Abdominal Wall Hematoma as a Rare Complication following Percutaneous Coronary Intervention

Abdominal wall hematoma is a rare but potentially serious vascular complication that may develop after coronary angiographic procedures. In particular, an oblique muscle hematoma caused by an injury of the circumflex iliac artery is very rare, yet can be managed by conservative treatment including hydration and transfusion. However, when active bleeding continues, angiographic embolization or surgery might be needed. In this study, we report an uncommon case of injury to the circumflex iliac artery by an inappropriate introduction of the hydrophilic guidewire during the performance of a percutaneous coronary intervention.

Sick Sinus Syndrome Following Severe Hyponatremia Associated with Desmopressin Therapy / 대한내과학회지

Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the arginine vasopressin that is widely used in the treatment of diabetes insipidus, nocturnal enuresis, and polyuria. Although it is generally well-tolerated, DDAVP can cause hyponatremia, especially in elderly patients. There are many reports of DDAVP-induced hyponatremia, but there has been only one case report in which sinus node dysfunction was caused by severe hyponatremia. Here we report a case of sick sinus syndrome that occurred during an episode of severe hyponatremia induced by chronic use of desmopressin in a 91-year-old man who had nocturnal enuresis.

Two Cases of Treatment with Thrombolysis and an Extracorporeal Membrane Oxygenator in Patients with Pulmonary Embolism and Cardiac Arrest / 대한내과학회지

Massive pulmonary embolism (PE) is associated with poor prognosis and high mortality. Moreover, patients with massive PE who present with shock have mortality rates ranging from 30% to 50%. Thrombolysis should be administered to patients with massive PE unless there are absolute contraindications to its use. However, treatment failure still occurs, and there is no consensus for the management of massive PE with cardiopulmonary arrest with regard to thrombolysis. In this study, two cases of massive PE with cardiopulmonary arrest are described, both of which were successfully treated with thrombolysis and hemodynamic support, which was administered by extracorporeal membrane oxygenation (ECMO). This report suggests that ECMO may provide safe and adequate cardiopulmonary support in patients with massive PE with refractory thrombolysis and cardiopulmonary arrest.

Percutaneous Thrombin Injection with Balloon Occlusion for the Treatment of a Femoral Artery Pseudoaneurysm / 대한내과학회지

Femoral artery pseudoaneurysm (FAP) is an uncommon but potentially serious vascular complication that may develop after cardiac and peripheral angiographic procedures. Here we describe the case of a 75-year-old female who presented with a life-threatening bleeding episode due to an FAP 4 days after diagnostic coronary angiography, which was treated with a percutaneous thrombin injection and transient balloon occlusion of the femoral artery during thrombin injection. This case reminds us of the importance of close observation and proper evaluation for complications, even if the risk of bleeding complications is low. Furthermore, although ultrasound-guided compression and a percutaneous thrombin injection are the standard treatment for FAP, this case demonstrates that transient balloon dilation during the percutaneous injection of thrombin is an important treatment option in cases of a wide-necked pseudoaneurysm in which the risk of thrombin escape is high.

A Case of Ticagrelor Rescue Therapy in a Patient with Subacute Stent Thrombosis / 대한내과학회지

Stent thrombosis (ST) is a rare but catastrophic complication of a drug-eluting stent. Although dual antiplatelet therapy with aspirin and clopidogrel significantly reduces the occurrence of ST, it continues to occur and is occasionally associated with clopidogrel resistance. Here, we describe a 71-yr-old man with subacute stent thrombosis and clopidogrel resistance following drug-eluting stent implantation who underwent successful ticagrelor rescue therapy.

A Case of Ticagrelor Rescue Therapy in a Patient with Subacute Stent Thrombosis / 대한내과학회지

Stent thrombosis (ST) is a rare but catastrophic complication of a drug-eluting stent. Although dual antiplatelet therapy with aspirin and clopidogrel significantly reduces the occurrence of ST, it continues to occur and is occasionally associated with clopidogrel resistance. Here, we describe a 71-yr-old man with subacute stent thrombosis and clopidogrel resistance following drug-eluting stent implantation who underwent successful ticagrelor rescue therapy.

A Case of Transient Hypertension after Blunt Abdominal Trauma / 대한내과학회지

Arterial hypertension following blunt abdominal trauma is a rare complication that can be induced by compression of the renal parenchyma due to a perirenal or subcapsular hematoma or adrenal hemorrhage. A 63-year-old woman was admitted after blunt abdominal trauma. Abdominal computed tomography (CT) revealed a right renal subcapsular hematoma and right adrenal gland hematoma. The patient developed hypertension during conservative treatment. Pheochromocytoma, renovascular hypertension, adrenal adenoma, thyroid disease, and other causes of secondary hypertension were excluded. On following the patient, her blood pressure normalized spontaneously without prescribing any antihypertensive medications. The renal subcapsular hematoma and adrenal hemorrhage regressed progressively as the blood pressure normalized. We report this case to make physicians aware that transient hypertension can develop in patients with blunt abdominal trauma, and to prevent the use of unnecessary antihypertensive medications.

A Case of Deep Vein Thrombosis after Coronary Angiography in a Patient Using Antidepressants and Anxiolytics

Deep vein thrombosis (DVT) is a rare but potentially serious complication of coronary angiography (CAG) affecting just under 5 in 10000 patients. Most of the cases regarding DVT after CAG reported in the literature were associated with procedure-related vascular complications or with risk factors for venous thromboembolism (VTE). Here, we describe the case of a 50-year-old woman during treatment for anxiety disorder, who developed significant DVT after CAG without a history of VTE and with no significant risk factors for VTE, which was treated with an anticoagulant. This case reminds us that clinicians should consider the possible occurrence of VTE after diagnostic CAG even in patients without significant risk factors.

A Case of Deep Vein Thrombosis after Coronary Angiography in a Patient Using Antidepressants and Anxiolytics

Deep vein thrombosis (DVT) is a rare but potentially serious complication of coronary angiography (CAG) affecting just under 5 in 10000 patients. Most of the cases regarding DVT after CAG reported in the literature were associated with procedure-related vascular complications or with risk factors for venous thromboembolism (VTE). Here, we describe the case of a 50-year-old woman during treatment for anxiety disorder, who developed significant DVT after CAG without a history of VTE and with no significant risk factors for VTE, which was treated with an anticoagulant. This case reminds us that clinicians should consider the possible occurrence of VTE after diagnostic CAG even in patients without significant risk factors.

A Case of Deep Vein Thrombosis Following Ultrasound-Guided Compression of a Pseudoaneurysm / 대한내과학회지

Femoral artery pseudoaneurysm (FAP) is one of the most troublesome groin complications related to femoral arterial access during invasive cardiovascular procedures. Ultrasound-guided compression is the initial treatment for FAP. Here, we describe the case of a 65 year-old female who developed significant deep vein thrombosis (DVT) following ultrasound-guided compression of FAP after percutaneous coronary intervention. She was successfully treated with anti-coagulation medications. This case, along with a brief review of the literature, should remind physicians of the possible occurrence of delayed vascular complications, such as DVT, after ultrasound-guided compression of FAP.

A Case of Transient Ischemic Attack and Cardiomyopathy Presented with Pheochromocytoma / 대한내과학회지

Patients with pheochromocytoma show a variety of clinical symptoms secondary to excessive catecholamine secretion. Major symptoms include hypertension, headache, hyperhidrosis, and palpitation. Stroke and myocardial infarction are known to occur in patients with pheochromocytoma, but the incidence is low. Here, we describe a 45-year-old female with a previous history of transient ischemic attack and a clinical presentation mimicking acute myocardial infarction with transient takotsubo-like myocardial dysfunction. A subsequent diagnostic examination revealed a left adrenal pheochromocytoma. The patient recovered with intensive medical treatment, including alpha- and beta-adrenergic blockade. Follow-up echocardiography revealed normalized cardiac function and wall motion. Thereafter, the patient underwent a laparoscopic left adrenalectomy without complications.