Ischemic Burden Assessment Using Single Photon Emission Computed Tomography in Single Vessel Chronic Total Occlusion of Coronary Artery

Background and Objectives@#Studies evaluating the nature of ischemic burden of chronic total occlusion (CTO) vessels are still lacking. @*Methods@#A total of 165 patients with single vessel CTO >2.5 mm in an epicardial coronary artery who underwent single photon emission computed tomography (SPECT) were enrolled in the study. Ischemic burden was calculated with the use of semi-quantitative SPECT analysis, and was defined as the summed difference score (SDS) divided by the maximal limit of the score (=SDS/68). @*Results@#The mean age of the participants was 59.5 years and the CTO of the left anterior descending coronary artery (LAD), left circumplex coronary artery (LCX), and right coronary artery (RCA) accounted for 93 (56.4%), 18 (10.9%), and 54 (32.7%) patients, respectively. The median ischemic burden of the total population was 8.8%, and it was highest in the LAD CTO (10.3%) compared with the LCX (5.9%) and RCA CTO (5.9%, p10%) was observed in 66 patients (40.0%), and in 47 patients (50.5%) of the LAD CTO. Ischemic burden was different according to the CTO location only in LAD CTO. The statistically significant predictors for high-ischemic burden were hypertension, baseline ejection fraction >45%, LAD CTO, proximal CTO location, and de novo CTO. Japanese-CTO score and Rentrop scale collateral grade were not associated with high-ischemic burden. @*Conclusions@#Only 40% of patients with single vessel CTO had ischemic burden >10%. For CTO vessels, measurement of ischemic burden using SPECT prior to revascularization may be helpful in identifying beneficial subjects.

Monitoring of Pyrethroid Resistance Allele Frequency in the Common Bed Bug (Cimex lectularius) in the Republic of Korea

Two-point mutations (V419L and L925I) on the voltage-sensitive sodium channel of bed bugs (Cimex lectularius) are known to confer pyrethroid resistance. To determine the status of pyrethroid resistance in bed bugs in Korea, resistance allele frequencies of bed bug strains collected from several US military installations in Korea and Mokpo, Jeollanamdo, from 2009-2019 were monitored using a quantitative sequencing. Most bed bugs were determined to have both of the point mutations except a few specimens, collected in 2009, 2012 and 2014, having only a single point mutation (L925I). No susceptible allele was observed in any of the bed bugs examined, suggesting that pyrethroid resistance in bed bug populations in Korea has reached a serious level. Large scale monitoring is required to increase our knowledge on the distribution and prevalence of pyrethroid resistance in bed bug populations in Korea. Based on present study, it is urgent to restrict the use of pyrethroids and to introduce effective alternative insecticides. A nation-wide monitoring program to determine the pyrethroid resistance level in bed bugs and to select alternative insecticides should be implemented.

Differential Diagnosis of a Left Atrial Mass after Surgical Excision of Myxoma: a Remnant or a Thrombus?

Echocardiographic diagnosis of atrial myxoma may not always be straightforward, and the distinction between myxoma and thrombi is not easy, especially when we observe a mass after successful surgery. Our report describes a 72-year-old woman who presented with right upper limb hemiparesis and was subsequently diagnosed as having transient ischemic attack due to a left atrial myxoma. One month after successful surgical resection of the tumor, the patient developed left-sided weakness. Echocardiography revealed a left atrial mass attached to the interatrial septum. Intravenous heparin was administered as a therapeutic trial for postoperative thrombi, which resulted in a decrease in mass size within a week. Anticoagulation with warfarin was continued, and complete resolution was demonstrated on a 4-month follow-up transesophageal echocardiography. This case highlights the fact that thrombus formation at the surgical site should be considered an unusual but potential complication after surgical resection of left atrial myxomas.

Non-Infective Endocarditis in a Patient with Rheumatoid Arthritis / 대한내과학회지

Pericarditis and atherosclerotic events are generally regarded as relatively common cardiac manifestations of rheumatoid arthritis (RA). However, RA-associated endocarditis is rarely reported, and can be confused (by clinicians) with an infective vegetation. Herein, we report a case of sterile endocarditis involving the mitral valve in a 36 year-old patient with longstanding RA; the problem was accidentally detected during performance of a valve operation.

A Case of Disseminated Cryptococcosis Mimicking Lung Cancer and Prostate Cancer in an Immunocompetent Patient: A Review of the Literature / 대한내과학회지

Cryptococcosis can occur in immunocompetent patients; in fact, it accounts for 20% of all cryptococcal infections. In immunocompetent patients, although clinical symptoms may not be obvious, cryptococcosis should be considered in the differential diagnosis for cancer and other diseases. We recently encountered a case of disseminated cryptococcosis involving the lung and prostate. A 71-year-old male patient was referred for evaluation of a large pleural effusion. He was a 40 pack-years ex-smoker, and showed no evidence of immunodeficiency. Chest computed tomography and positron emission tomography images suggested primary lung cancer with pleural metastases and prostate cancer. Tuberculous pleurisy was suspected due to a lymphocyte-dominant exudative pleural effusion and high level of adenosine deaminase. Prostate and bronchoscopic biopsies demonstrated chronic granulomatous inflammation, and periodic acid Schiff's and Grocott's methenamine silver staining confirmed cryptococcosis in both specimens. Antifungal therapy with fluconazole was started, and follow-up images showed complete resolution of the pleural effusion.

A Comparison Study of Ballooning Time between Immediate and Conventional Deflation Method of Endoscopic Papillary Large Balloon Dilation for the Extraction of Difficult Bile Duct Stone / 대한췌담도학회지

BACKGROUND/AIMS: The ballooning time in endoscopic papillary large balloon dilation (EPLBD) remains controversial. The aim of this study was to evaluate the significance of the ballooning time comparing an immediate balloon deflation method with a conventional ballooning time of > 45 seconds. METHODS: Between January 2010 and December 2010, 126 patients with bile duct stones treated with EPLBD and endoscopic sphincterotomy were divided according to the ballooning time: the immediate deflation group (n=56) and the conventional inflation group (ballooning time 45s to < 60s) (n=70). RESULTS: The overall success rate and the success rate of the first attempt of ERCP (endoscopic retrograde cholangio-pancreatography) were 96.4% (54/56) and 80.4% (45/56) in the immediate group and 97.1% (68/70) and 77.1% (54/70) in the conventional inflation group. There were no statistically significant differences in the overall success and the first attempt of ERCP success rate (p=0.99, p=0.66). The frequency of mechanical lithotripsy was 0% in the immediate deflation group and 7.1% in the conventional inflation group (p=0.065). Complications occurred in 3.6% (2/56) patients in the immediate deflation group and 8.6% (4/70) patients in the conventional inflation group (p=0.298). CONCLUSIONS: The ballooning time in EPLBD does not affect the outcomes of the treatment for bile duct stones. And the feasibility of the immediate deflation method in EPLBD is acceptable.

Ipsilateral leg swelling after renal transplantation as an alarming sign of Iliac vein stenosis

Iliac vein stenosis is a rare vascular complication of renal transplantation that may compromise allograft function if not recognized and corrected in a timely fashion. Because chronic venous stenosis may remain undiagnosed for several years, a high index of suspicion should be maintained until diagnosing this rare disease. A 56-year-old renal transplant recipient presented with unilateral leg swelling and renal dysfunction 16 years after transplantation. Computed tomography excluded deep vein thrombosis and revealed tight iliac vein stenosis on the side of the renal transplant. Following angiographic confirmation of the stenosis, endovascular treatment was successfully performed with a purposefully designed, self-expanding, venous stent. Ipsilateral leg swelling is an alarming sign for the diagnosis of iliac vein stenosis after renal transplantation. Percutaneous intervention with venous stent placement seems to be a safe and effective treatment of this rare condition.

A study of consumers' perceptions and prediction of consumption patterns for generic health functional foods

The Korea Food and Drug Administration (KFDA) revised the Health Functional Food Act in 2008 and extended the form of health functional foods to general food types. Therefore, this study was performed to investigate consumers' perceptions of the expanded form of health functional food and to predict consumption patterns. For this study, 1,006 male and female adults aged 19 years and older were selected nationwide by multi-stage stratified random sampling and were surveyed in 1:1 interviews. The questionnaire survey was conducted by Korea Gallup. The subjects consisted of 497 (49.4%) males and 509 (50.6%) females. About 57.9% of the subjects recognized the KFDA's permission procedures for health functional foods. Regarding the health functional foods that the subjects had consumed, red ginseng products were the highest (45.3%), followed by nutritional supplements (34.9%), ginseng products (27.9%), lactobacillus-containing products (21.0%), aloe products (20.3%), and Japanese apricot extract products (18.4%). Opinions on expanding the form of health functional foods to general food types scored 4.7 points on a 7-point scale, showing positive responses. In terms of the effects of medicine-type health functional foods versus generic health functional foods, the highest response was 'same effects if the same ingredients are contained' at a rate of 34.7%. For intake frequency by food type, the response of 'daily consistent intake' was 31.7% for capsules, tablets, and pills, and 21.7% for extracts. For general food types, 'daily consistent intake' was 44.5% for rice and 22.8% for beverages, which were higher rates than those for medicine types. From the above results, consumers had positive opinions of the expansion of health functional foods to generic forms but are not expected to maintain accurate intake frequencies or amounts. Thus, continuous promotion and education are needed for proper intake of generic health functional foods.

Suppressed Gastric Mucosal TGF-beta1 Increases Susceptibility to H. pylori-Induced Gastric Inflammation and Ulceration: A Stupid Host Defense Response

BACKGROUND/AIMS: Loss of transforming growth factor beta1 (TGF-beta1) exhibits a similar pathology to that seen in a subset of individuals infected with Helicobacter pylori, including propagated gastric inflammation, oxidative stress, and autoimmune features. We thus hypothesized that gastric mucosal TGF-beta1 levels could be used to determine the outcome after H. pylori infection. METHODS: Northern blot for the TGF-beta1 transcript, staining of TGF-beta1 expression, luciferase reporter assay, and enzyme-linked immunosorbent assay for TGF-beta1 levels were performed at different times after H. pylori infection. RESULTS: The TGF-beta1 level was markedly lower in patients with H. pylori-induced gastritis than in patients with a similar degree of gastritis induced by nonsteroidal anti-inflammatory drugs. There was a significant negative correlation between the severity of inflammation and gastric mucosal TGF-beta1 levels. SNU-16 cells showing intact TGF-beta signaling exhibited a marked decrease in TGF-beta1 expression, whereas SNU-638 cells defective in TGF-beta signaling exhibited no such decrease after H. pylori infection. The decreased expressions of TGF-beta1 in SNU-16 cells recovered to normal after 24 hr of H. pylori infection, but lasted very spatial times, suggesting that attenuated expression of TGF-beta1 is a host defense mechanism to avoid attachment of H. pylori. CONCLUSIONS: H. pylori infection was associated with depressed gastric mucosal TGF-beta1 for up to 24 hr, but this apparent strategy for rescuing cells from H. pylori attachment exacerbated the gastric inflammation.

Food safety knowledge and practice by the stages of change model in school children

In this study, 342 grade 4-6 elementary school students in Gyeonggi-do were recruited to determine their readiness to change food safety behavior and to compare their food safety knowledge and practices by the stages of change. The subjects were divided into three stages of change; the percentage of stage 1 (precontemplation) was 10.1%, the percentage of stage 2 (contemplation and preparation) was 62.4%, and that of stage 3 (action and maintenance) was 27.5%. Food safety knowledge scores in stage 3 (4.55) or stage 2 (4.50) children were significantly higher than those in stage 1 children (4.17) (P < 0.05). The two food safety behavior items "hand washing practice" and "avoidance of harmful food" were significantly different among the three groups (P < 0.05). Stages of change were significantly and positively correlated with food safety knowledge and practice. Age was significantly and negatively correlated with the total food safety behavior score (r = -0.142, P < 0.05). The most influential factor on the stage of change was a mother's instruction about food safety (P < 0.01).

Elementary, Middle and High School Teachers' Opinions of School Foodservice Programs

This study investigated elementary, middle, and high school teachers' satisfaction, nutrition education, workload changes, and demands in school foodservice programs (SFPs). The subjects were 630 teachers at 12 elementary, 9 middle, and 9 high school within the nation. Ninety five percent of the teachers felt that there was a necessity for SFPs. Middle school teachers (MTs) and high school teachers (HTs) thought that it was necessary in order to reduce the students'burden of carrying lunch boxes. The teachers were relatively satisfied with their school's foodservice management types, food distribution types, meal quality, and sanitation. Elementary teachers (ETs) and HTs had a higher satisfaction than MTs. Teachers thought that SFPs had positive effects on their students' nutrition and health, enhancing desirable eating habits, and socialization. ETs had more positive opinions than MTs or HTs. ETs and MTs thought that their workload had been increased by SFPs more than HTs, but they had relatively positive opinions on the workload change. ETs taught nutrition and health through SFPs more frequently than MTs or HTs. Many teachers thought that there was a lack of appropriate teaching materials. Some teachers thought that the problems in the present SFPs were: a lack of cafeteria facilities, poor quality of meals, and management of leftovers. Their demands for SFPs were a improvement of meal quality and the establishment of cafeterias. In conclusion, MTs had more negative opinions than ETs or HTs. ETs perceived that SFPs had a function as an important educational activity as well as the supply of nutritional meals. MTs or HTs tended to consider only a meal. It is suggested that teachers, especially MTs and HTs, should modify their attitudes and recognize the educational functions of SFPs. Training programs should be developed under government auspices.

A Suggestion to Develop a Nutrition Policy on Food and Nutrition Labeling and Education Systems for Fast Food and Carbonated Soft Drinks in Korea

The objective of this study is to develop a nutrition policy on food and nutrition labeling and education systems for fast food and carbonated soft drinks in Korea by identifying the fast food and soft drink use and by examining nutrition policies and labeling in Korea and other countries. Fast food is defined as food dispensed quickly at a restaurant generally offering a limited menu of inexpensive items, which may be mostly not nutritious. It is a growing component of the Korean diet, especially on children and adolescent population. Low nutrient dense beverages such as carbonated drinks are also increasing in the children and adolescent's diet in Korea and concern has been raised that these beverages may replace more nutritious beverage and provide empty calories. According to 2001 Korean national health and nutrition survey, fast food and carbonated soft drinks were most popular among 13 - 19 years old adolescents. Thirty six and 72 percent of adolescents consumed hamburger and carbonated beverage equal to or more than once a week, respectively. In United States, all processed food including soft drinks should disclose full nutrition information by nutrition labeling requirement. Restaurant foods are not required to provide nutrition information currently, but legislation on mandatory nutrition labeling of fast foods with other restaurant foods has been proposed currently in US. The sales of foods of minimal nutritional value, such as soft drinks, in the nation's schools is regulated by the United States Department of Agriculture. Nutrition information about fast food in US has been provided by fast food companies, non-profit organizations, hospitals and government through internet, booklet and brochure, etc, but the information is available from only a few resources in Korea. This study suggests a nutrition policy on fast food and soft drink use which includes establishing mandatory nutrition labeling and developing nutrition education materials and programs by web-site, booklet and government and school programs in Korea.

Effects of Soyoligosaccharide on Lipid Metabolism in Rats Fed the High Fat or Low Fat Diet

This study investigated the effects of soyoligosaccharide consumption on lipid profile of plasma, liver and feces and immune responses in Sprague-Dawley male rats. Sixty male Sprague-Dawley rats 4-wk-old were provided the soyoligosaccharide containing diets for 4 weeks (0, 100 g/kg diet); each of these diets was supplemented with either 70 or 200 g fat/kg diet, giving a total of 4 experimental groups. The effect of weight reduction was most significantly observed in the group fed low fat and soyoligosacchairde diet. The plasma total lipid and cholesterol contents were not changed by either fat proportion or soyoligosaccharide supplementation in the diets. Also the plasma triglyceride lowering effect by soyoligosaccharide was not observed in rats fed either low fat or high fat diet. However, the significant decrease in TG contents was found with rats fed high fat diets compared to the control/no soyoligosaccharide diet. Elevation of plasma LDL-cholesterol and reduction of HDL-cholesterol by feeding high fat diet was not altered by supplementing soyoligosaccharide. This was also applied to the liver lipid profiles. The significant increases in liver total lipid, triglycerides and cholesterol by high fat diet was not abolished by feeding soyoligosaccharide. However, the desirable effects of feeding soyoligosaccharide were found with total lipid and cholesterol excretion through feces in rats fed high fat diets. Immune organ weights and spleen cell proliferations did not affected by experimental diets. These results demonstrated that soyoligosaccharide intakes increased the lipid output via feces, especially in rats fed the high fat diet, but more researches are needed on immune responses.

Effects of Acorn Supplementation on Lipid Profiles and Antioxidant Enzyme Activities in High Fat Diet-Induced Obese Rats

This study was performed to investigate the effect of acorn supplementation on the lipid profile and redox antioxidant enzyme activities in obese rat. Obesity in the rats was induced by feeding diet contained 10% lard and 0.5% cholesterol for 4 week. After 4 weeks, rats were divided into the following 5 groups; high fat diet (Control), high fat diet plus 10% Acorn powder (AP10%), high fat diet plus 20% Acorn powder (AP20%), high fat diet plus 0.2% Acorn extract (AE0.2%), high fat diet plus 0.5% Acorn extract (AE0.5%). Total food intake and food efficiency ratio (FER) was not significantly different by acorn powder and extract supplementation. But, body weight was decreased by 20% acorn powder. Acorn powder and extract supplementation for 4 weeks tend to decrease total cholesterol and triglyceride level on the serum and hepatic tissue. There was no significant difference in hepatic glutathione (GSH) content among all the groups. The hepatic GST activity in acorn supplemented groups was lower than that of control. Glutathione peroxidase and catalase activities were higher in acorn supplemented groups than that of control. Hepatic TBARS levels of experimental groups were also significantly lower than that of control group. Our finding suggest that acorn powders and extract might have potential role for improving lipid profiles and antioxidant enzyme activities in obese rats.

Comparisons of Student Satisfaction with the School Food Service Programs in Middle and High Schools by Food Service Management Types

This study on satisfaction with school food service (FS) programs was conducted with 485 middle school students and 515 high school students based on FS management type. There were four types of FS management: independent-conventional (IC), independent-commissary (ICM), contract-conventional (CC), and contract-delivery (CD). About seventy percent of the students expressed satisfaction with the food quantity of the school lunches. But one third of the students, who felt the quantity was insufficient, cited the small size of the rice serving. Many high school students cited the small size of the side dishes as well as the rice serving. It is suggested that the meal quantity should be determined in consideration of the students' physical development. The satisfaction with FS sanitation was lower than that with the meal quality, eating environment, and environment of dining room with respect to all four types of FS management, and was lowest in the CD. It is suggested that FS sanitation should be managed more thoroughly for the students' safety, and that the school FS Committee should carefully monitor the sanitary management of the contract FS companies by means of a well-designed and monitored management system. Most of middle and high school students expected good taste and a diversity of foods in their school lunches. Food taste should be improved, and various food materials and cooking methods should be used for balanced nutrition and greater student satisfaction, particularly in contract FS types (CC and CD).