Acupuncture alters pro-inflammatory cytokines in the plasma of maternally separated rat pups / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the potential alleviating effects of acupuncture on maternal separation (MS)-induced changes in plasma pro-inflammatory cytokine levels of rat pups.</p><p><b>METHODS</b>On postnatal day 15, rat pups were randomly assigned to 4 groups (n=6 per group) using a random number table: normal, MS, MS with acupuncture stimulation at Shenmen (HT 7) acupoint (MS+HT 7), and MS with acupuncture stimulation at Chengshan (BL 57) acupoint (MS+BL 57) groups. Rat pups in the normal group were housed with their mothers under standard conditions; those in the MS, MS+HT 7 and MS+BL 57 groups were maternally separated and individually maintained. Acupuncture stimulation was performed at HT 7 or BL 57 acupoints once a day for 7 consecutive days. A tail suspension test was performed to measure immobility time of rats and the plasma was collected on postnatal day 21, then levels of corticosterone (CORT), interleukin (IL)-1β, IL-6 and glial cell-derived neurotrophic factor (GDNF) in plasma were measured.</p><p><b>RESULTS</b>Compared with the normal group, the immobility time and the plasma levels of CORT, IL-1β, IL-6 and GDNF in the MS group were significantly increased (P<0.05 or P<0.01). Compared with the MS group, the immobility time and the plasma levels of CORT, IL-1β, IL-6 and GDNF were significantly reduced in the MS+HT 7 group (P<0.05 or P<0.01). Moreover, the immobility time and plasma levels of IL-1β and IL-6 in the MS+HT 7 group were significantly lower than those in the MS+BL 57 group (P<0.05).</p><p><b>CONCLUSION</b>Acupuncture stimulation at HT 7 can alleviate the behavioral impairment and changes of the cytokines by MS, indicating that acupuncture can help to relieve MS-induced depression.</p>

Impact of Doctors' Resistance on Success of Drug Utilization Review System / 대한의료정보학회지

OBJECTIVES: The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system. METHODS: This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012. RESULTS: This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction. CONCLUSIONS: The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.

Practical Use and Risk of Modafinil, a Novel Waking Drug

OBJECTIVES: Modafinil is a waking drug prescribed to narcolepsy patients, but its usage among healthy individuals is increasing to enhance their alertness or to mitigate fatigue. This study was conducted to investigate practical use and toxic effects on neuro-immune interaction of modafinil. METHODS: This study reviewed the significance of psychoactive drugs, and discussed the benefits and risks of the application of modafinil, which seems to be ideal as an anti-psychotic or anti-fatigue agent. RESULTS: Modafinil is known to have less or no adverse effects than those found in traditional psychostimulants such as amphetamine, methylphenidate or cocaine. It can be applied as an anti-psychotic or anti-fatigue agent. However, the waking mechanism of modafinil is yet to be fully revealed. Recent studies reported that modafinil may be subject to abuse and addiction. In addition prolonged sleeplessness induces stress responses and impairs immune function. CONCLUSIONS: Modafinil can be used by anyone, who wishes to work late, stay awake, enhance their cognitive reactions, or brighten their moods. Users may already be under a great level of stress, i.e. cancer patients or soldiers in a battle field. A psychoneuroimmunological approach is thus needed to investigate the multi-functional effects of modafinil.

Technical Considerations for Successful Implementation of a Barcode-based Medication System in Hospital / 대한의료정보학회지

OBJECTIVE: To identify the technical considerations in implementing a barcode-based medication system and propose practical solutions for successful implementation of the system. In order to reduce medical errors related to medication and blood transfusion, we analyze various factors that hinder the successful implementation of the barcode-based medication system and discuss issues involved in the effective adoption of such a system. METHODS: The barcode-based medication system of this research uses one-dimensional, barcode bands on patients' wrists and two-dimensional barcodes attached to drug bags and blood bags. PDAs with barcode reading capability and wireless networking function are used, which enables Point of Care. The business process for applying the developed system and the current status of the system usage are analyzed. RESULTS: The factors causing a variety of system failures in the demonstration and pilot periods were identified and categorized as including PDA malfunction, PDA battery discharge due to users' carelessness, confusion in reading barcodes and so on. CONCLUSIONS: It is expected that the analyzed obstructive factors and the proposed technical considerations addressed in this paper can help other hospitals implement similar barcode-based medication systems successfully. Ultimately, this research will contribute to reducing medical errors and improving quality of patient care.

A Case of Acute Ventricular Capture Threshold Rise Associated with Flecainide Acetate

Antiarrhythmic agents may increase capture threshold, but this is rarely of clinical significance. Flecainide acetate, a class IC agent, is reported to have a significant effect on the myocardial capture threshold. In this presentation, we report the case of a 72-year-old male, with a previously implanted VVI pacemaker due to sick sinus syndrome, who was treated with flecainide acetate for paroxysmal atrial arrhythmia control. During the fifteenth day of treatment, an abrupt rise in the ventricular capture threshold with ventricular pacing failure was noted. The capture threshold decreased two days after discontinuation of flecainide acetate.

Serum Levels of Advanced Glycation End Products Are Associated with In-Stent Restenosis in Diabetic Patients

The formation of advanced glycation end products (AGEs), in various tissues has been known to enhance immunoinflammatory reactions and local oxidant stresses in long standing diabetes. Recently, AGEs have been reported to play a role in neointimal formation in animal models of arterial injury. We attempted to determine whether the serum levels of AGEs are associated with coronary restenosis in diabetic patients. Blood samples were collected from diabetic patients with coronary artery disease undergoing stent implantation and the serum levels of AGEs were analyzed by the fluorescent intensity method. The development of in-stent restenosis (ISR) was evaluated by a 6-month follow-up coronary angiography. A total of 263 target lesions were evaluated, in 203 patients. The ISR rate in the high-AGE (> 170 U/ml) group (40.1%) was significantly higher than in the low-AGE group (< or =170 U/ml) (19.6%) (p < 0.001). Furthermore, multivariate analysis revealed that a high level of serum AGEs is an independent risk factor for the development of ISR (odds ratio, 2.659; 95% CI, 1.431-4.940; p=0.002). The serum levels of AGEs constitute an excellent predictive factor for ISR, and should be one of the guidelines for medical therapy and interventional strategy to prevent ISR in diabetic patients.

Time-Phasic Development of Nitrate Tolerance According to the Hemodynamic Responses and the Expression of Phosphodiesterase 1A1

BACKGROUND AND OBJECTIVES: Time-phasic development of nitrate tolerance in cardiovascular diseases is very important because it can contribute to the advent of blunted vasodilation or rebound ischemia even during continuous NTG treatment. In such a condition, we should change the therapeutic regimen of nitrate treatment to prevent the worsening of symptoms. MATERIALS AND METHODS: We created a nitrate-tolerant rat model using an osmotic minipump, and we examined the hemodynamic response to bolus NTG infusion in vivo. We checked the phosphodiesterase (PDE) 1A1 mRNA and protein level by relative quantitative RT-PCR and western blot analysis. We used 8-cpt-cGMP for investigating the development of a time-phasic nitrate tolerance mechanism after nitrate infusion. RESULTS: NTG-treated rats revealed a significant decrease in NTG-induced MAP drop (nitrate tolerance) from 1-day and this continued to the third day. The mRNA and protein levels of PDE1A1 similarly increased during these periods. CONCLUSION: This study revealed the development of time-phasic nitrate tolerance from the the aspects of in vivo hemodynamic responses and PDE 1A1 gene expression, and our work supports the need for further investigation to come up with a different therapeutic strategy and new drugs.

Integrated Pharmaceutical Supply Chain Management based on B2B Collaboration and Information Sharing / 대한의료정보학회지

OBJECTIVE: The objective of this research is to design and develop an integrated pharmaceutical supply chain management(SCM) system for optimizing inventory control and reducing material handling costs based on B2B collaboration and information sharing. METHODS: We have analyzed business processes of material handling in hospitals and reviewed system requirements for efficient supply chain management. VMI(Vendor-Managed Inventory), which is one of important applications of SCM, has been adopted. Online procurement system and Web-based information sharing system are developed for the integration of the SCM. RESULTS: The SCM system composed of VMI, CAO(Computer Aided Ordering), and Web-based information sharing system enables hospitals to optimize the procurement processes and inventory control of pharmaceutical products. By sharing information with hospitals, the wholesaler can get information more timely and use exact data about inventory status and drug usage volumes of hospitals, so that it can forecast future demand more accurately, which facilitates needed products to be supplied timely and cost-effectively. CONCLUSION: By the B2B collaborations and information sharing among SCM participants, the SCM system have been implemented successfully in the medical center. It improves material handling of hospitals, reducing inventory management costs and ultimately improving quality of patient care.

Hypertension and Vascular Disease: Pharmacologic Management of Hypertension / 대한뇌혈관외과학회지

Hypertension is one of the common diseases nowadays. In the aspects of management, the precise prevention of its complications is more important than normalization of blood pressure level itself. Systemic considerations for medical treatment such as side effects, efficacy, compliance for medicine, long-term evaluation of complications should be the essential points of medical treatment for hypertension.

Assessment of Extent of Myocardial Ischemia in Patients with Non-ST Elevation Acute Coronary Syndrome Using Serum B-type Natriuretic Peptide Level

Since B-type natriuretic peptide (BNP) concentration has been shown by recent studies to be elevated in patients presenting acute coronary syndrome (ACS) even in the absence of overt heart failure, other mechanisms for elevating plasma BNP (p-BNP) concentrations may be suggested to exist. We have studied the correlation between p-BNP level and the extent of myocardial ischemia (EMI) in non-ST elevation (NSTE) ACS and evaluated the BNP level as an objective marker of EMI. In 204 patients with NSTE ACS, we estimated the EMI by the echocardiographic wall motion score index (WMSI) and the coronary angiographic Gensini score. As the positive control group, 44 patients with stable angina were enrolled into the study. We compared their initial p-BNP levels with WMSI and the Gensini score. Additionally, peak troponin-T level was compared with p-BNP level in NSTE myocardial infarction (MI) patients. Using the multiple regression analysis, adjustments for age, left ventricle (LV) wall stress, LV mass amount and ejection fraction (EF) were made. Patients with LVEF 75 years or underlying diseases that could elevate BNP levels were excluded from the study. P-BNP level was increased in NSTE ACS patients compared with stable angina patients (133.9 +/- 87.4 vs. 12.2 +/- 9.2 pg/ml, p < 0.05). P-BNP levels were found to correlate with WMSI and the Gensini score in unstable angina (r=0.519, p < 0.01; r=0.680, p < 0.01) and NSTEMI (r=0.716, p < 0.01; r=0.684, p < 0.01) patients, respectively. Additionally, p-BNP levels correlated with the peak troponin-T level in patients with NSTEMI (r=0.700, p < 0.01). P-BNP level might be a useful marker in the assessment of EMI.

A Case of Pulmonary Artery Intimal Sarcoma Diagnosed with Multislice CT Scan with 3D Reconstruction

Pulmonary artery intimal sarcoma is a rare highly lethal disease, with additional retrograde extension to pulmonic valve and right ventricle being an extremely rare condition. It is frequently mistaken for pulmonary thromboembolism. We report a case of 64-year-old woman with progressive dyspnea initially suspected and treated for pulmonary thromboembolism. Her helical chest CT scan with 3 dimensional (3D) reconstruction combined with echocardiography revealed a compacting main pulmonary artery mass extending to the right ventricular outflow tract and the right pulmonary artery. After excision of the mass, the patient's condition improved dramatically, and the pathologic findings revealed pulmonary intimal sarcoma. This report emphasizes that helical chest CT with 3D reconstruction can be an important tool to differentiate the characteristics of pulmonary artery lesions, such as intimal sarcoma and thromboembolism.

Effects of B2B E-Commerce in the Material Management of Hospitals / 대한의료정보학회지

The objectives of this study were to examine effects of B2B e-commerce on the material management by comparing the performance of B2B and non-B2B hospitals, and surveying the extent of the objective of B2B implementation was achieved and success and failure factors of the implementation. Managerial data from six hospitals, three B2B and three non-B2B, and survey data from 107 employees involved in the material management at the study hospitals were analyzed. The number of employees at the department of purchasing, time spent for placing order, cycle time from order to delivery were better at the B2B hospitals, and employees' satisfaction with the material management system was significantly higher in the B2B hospitals than in the non-B2B hospitals as well. However, intended effects of B2B e-commerce in wider areas of the material management such as inventory management and sharing of business information were not substantiated in this study. The study results indicated that B2B ecommerce in the study hospitals improved work efficiency and effectiveness in the area of procurement, and implied needs for an ERP-type system and process reengineering with the implementation of B2B e-commerce to obtain wider ranges of effects in the material management. Also the study results implied a need for communication with employees during the course of implementation for the system success.

Correlation of N-Terminal Pro-Brain Type Natriuretic Peptide Level and Echocardiographic Parameters / 대한진단검사의학회지

BACKGROUND: N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been identified as a promising biochemical marker for congestive heart failure (CHF). Recently, the NT-proBNP assay using electrochemiluminescence method has been developed. We evaluated clinical utilities of the NT-proBNP assay and its relationship with echocardiographic parameters. METHODS: The NT-proBNP was measured in eighty-four patients who experienced an echocardiographic examination. We compared the NT-proBNP level with several echocardiographic parameters for the left ventricular systolic function and cardiac chamber dimensions. RESULTS: The NT-proBNP level was significantly increased as with a decreasing left ventricular ejection fraction (LVEF). It was also positively correlated with the left ventricular mass, left ventricular mass index, left ventricular end diastolic dimension, and left ventricular end systolic dimension. In patients with left atrial and ventricular enlargement, the mean NT-proBNP level was 7418.4 +/-9937.7 pg/mL, which was significantly elevated compared with 354.3 +/-749.8 pg/mL in patients with normal cardiac chamber dimensions (P<0.001). CONCLUSIONS: The NT-proBNP showed a significant correlation with echocardiographic parameters, especially for the systolic function and chamber enlargement. Therefore, the NT-proBNP seemed to be a new and promising alternative biochemical marker for CHF.

Effect of Angiotensin II on Gene Expression of cGMP-Specific Phosphodiesterases

BACKGROUND AND OBJECTIVES: Angiotensin II (Ang II) opposes the actions of nitric oxide (NO). A balance between Ang II and NO is critical for the maintenance of normal vessel tone, and is dependent on the intracellular cGMP level. We examined the effect of Ang II treatment on cGMP-hydrolyzing phosphodiesterases (PDEs), such as PDE1 and PDE5, the two major cGMP-hydrolyzing PDEs present in rat aortic vascular smooth muscle cells (VSMCs). We also investigated whether the Ang II signaling pathway affects the expression of the cGMP-hydrolyzing PDEs gene. MATERIALS AND MEDHODS: VSMCs from Sprague-Dawley rats were incubated. Relative quantitative RT-PCR was performed for quantitation of PDE1A1, PDE5A1 mRNA expression a following in vitro Ang II treatment, and also done after pretreatment with inhibitors of the Ang II type1 (AT1) receptor, protein kinase C (PKC), mitogen activated protein kinase kinase (MEK) 1/2 and janus kinase 2 (JAK2) to investigate the effect of the Ang II signaling pathway on PDE1A1, PDE5A1 gene expression. Western blot analyses were performed to evaluate the changes of PDE1A1 and PDE5A1 protein level following treatment with Ang II. RESULTS: Ang II (400 nM) increased the PDE1A1 and the PDE5A1 mRNA expression by 2.4 and 2.3-fold, respectively, 1 hour after treatment. Ang II also increased the protein level 2 hours after treatment. Inductions of PDE1A1 and PDE5A1 mRNA were blocked by the AT1 receptor inhibitors, PKC, MEK 1/2 and JAK2. CONCLUSION: In vitro Ang II treatment upregulates the PDE1A1, PDE5A1 gene expressions and the protein levels. The PKC, MEK1/2 and JAK2 signaling pathways were essential for the Ang II-mediated PDEs gene regulation. These findings may suggest that Ang II antagonizes NO actions through the upregulation of cGMP-hydrolyzing PDEs gene expressions.

A Case of Antiphospholipid Antibody Syndrome Accompanied by Valvular Heart Disease and Moya Moya Syndrome

A case of antiphospholipid antibody syndrome, accompanied by valvular heart disease and Moya moya syndrome, has never been reported. Here, we report on a case that had mitral regurgitation and Moya moya syndrome, associated with antiphospholipid antibody syndrome secondary to systemic lupus erythematosus. This patient underwent a mitral valve replacement for mitral valve regurgitation. The postoperative course was uneventful, and the pathological findings of the mitral valve showed a degenerative change, due to chronic inflammation, a proliferative fibrous change and calcification, but without thrombus formation. However, the patient returned to the hospital with a cerebral hemorrhage, which was caused by Moya moya syndrome. Surgical drainage was performed, and the patient was discharged without any complications. The patient is on anticoagulation and immunosuppression drugs, with no problems to date.

A Case of Abdominal Aortic Interruption Presented with Secondary Hypertension

Aortic interruption is a very rare disease that can be classified into congenital and acquired aortic interruption. Congenital aortic interruption generally implies an interruption of the aortic arch and no case of congenital abdominal aortic interruption has been reported. Acquired aortic interruption, on the other hand, can be caused by atherosclerosis, thrombosis, saddle embolism, and arteritis such as Takayasu arteritis. We experienced a case of congenital abdominal aortic interruption accompanied by one well-developed collateral flow presented with secondary hypertension in a 28-year-old female patient.

The Effects of Plasma Fibrinogen and beta Fibrinogen Gene Polymorphisms on the Development of Coronary Artery Disease

No abstract available.

The Effects of Plasma Fibrinogen and beta Fibrinogen Gene Polymorphisms on the Development of Coronary Artery Disease

No abstract available.

Apoptosis in dilated cardiomyopathy

OBJECTIVE: Cardiomyopathy, a popular diagnosis that always obscures more than it reveals, nevertheless has several characteristic histological features. These prominently include widespread focal myocardial fibrosis and associated hypertrophy of surviving cardiac myocyte. In fact, focal noninflammatory degeneration (not necrosis) has been demonstrated as a feature of many forms of cardiac hypertrophy. We hypothesized that this loss of myocardial cells in dilated cardiomyopathy (DCMP) may result from cell death by apoptosis. METHODS: Endomyocardial biopsy specimens from the right ventricles of six patients who suffered from DCMP were studied, and myocardial specimens from two persons who died in motor vehicle accidents were used as negative controls. For identification of apoptosis, immunohistochemistry with terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end-labeling was performed. In addition, apoptosis was confirmed morphologically by confocal laser scanning microscopy with propidium iodide. RESULTS: Apoptosis, that was represented by an apoptotic index ranging from 19.8 to 25.4+ACU-, could be extensively seen in myocytes and also rarely in non-myocytes of interstitium and vascular endothelium. Morphologically, there were a lot of nuclei with clumps of condensed chromatin, suggestive of apoptosis. CONCLUSION: The present study demonstrated that myocyte loss in DCMP might be mainly due to the apoptosis of myocytes and interstitial cells, rather than inflammation or cell necrosis.

Expression of leptin receptor (Ob-R) in human atherosclerotic lesions: potential role in intimal neovascularization

Neovascularization of the adventitial vasa vasorum with extension into the intima of atherosclerotic lesions is frequently observed, but its pathophysiological significance is still subject to debate. Recently, leptin, the product of the Ob gene, was identified. Leptin, via activation of the endothelial receptor (Ob-R), generates a growth signal involving a tyrosine kinase-dependent intracellular pathway and promotes angiogenic processes. We hypothesized that a high concentration of leptin within vasa vasorum and plaque itself, may influence inflammatory and vascular neovascularization coupling with functional upregulation of the vascular endothelial growth factor (VEGF). Microscopic computerized tomography was utilized for the spatial distribution of vasa vasorum and intimal neovascularization from atherosclerotic human coronary arteries. Atherosclerotic coronary arteries showed a dense plexus of microvessels in the adventitia and plaque itself. Microscopic analysis from human atherosclerotic aortas revealed an increase in the intimal thickness with neovascularization. The immunoreactivity for Ob-R, VEGF and matrix metalloproteinase (MMP) increased in atherosclerotic plaque, predominantly in the endothelial lining of the intimal neovessel and macrophages/foam cells. Our observation of a prominent colocalization between Ob-R, VEGF and MMP supports this hypothesis and these factors participate in the neovascularization of atherosclerotic lesions. The present study is the first report on vascular tissue and it opens a promising perspective concerning future investigations of leptin-dependent modulation of atherogenesis and vascular neovascularization under pathophysiolgical conditions.