Lifestyle Modification in the Management of Metabolic Syndrome:Statement From Korean Society of CardioMetabolic Syndrome (KSCMS)

With the recent rapid increase in obesity worldwide, metabolic syndrome (MetS) has gained significant importance. MetS is a cluster of obesity-related cardiovascular risk factors including abdominal obesity, atherogenic dyslipidemia, high blood pressure and impaired glucose tolerance. MetS is highly prevalent and strongly associated with an increased risk of developing diabetes and cardiovascular disease, putting a great burden on human society. Therefore, it is very important to reduce MetS risk, which can improve patients’cardiovascular prognosis. The primary and most effective strategy to control each component of MetS is lifestyle change such as losing body weight, keeping regular exercise, adopting a healthy diet, quitting smoking and alcohol drinking in moderation. Many studies have shown that lifestyle modification has improved all components of MetS, and reduces the incidence of diabetes and cardiovascular disease. Here, the Korean Society of CardioMetabolic Syndrome has summarized specific and practical methods of lifestyle modification in the management of MetS in the healthcare field.

Association of Sleep Duration with Hand Grip Strength in Adults: Korea National Health and Nutrition Examination Survey (2014–2017)

Background@#Hand grip strength (HGS) is used clinically with regards to rehabilitation and recommended as a basic measure in determiningmusculoskeletal function, weakness, and disability. The purpose of this study was to examine the relationship between sleep duration and musclestrength in Korean adults. @*Methods@#The Korea National Health and Nutrition Examination Survey (KNHANES) is a cohort survey investigating the health behavior, chronic diseaseprevalence, and food and nutrition intake statuses of the Korean population. We analyzed the association between sleep duration and hand gripstrength by performing a logistic regression analysis on KNHANES data from 2014 to 2017. All statistical analyses were performed with SPSS and Rtools. @*Results@#Among the 20,933 participants, compared to the group of patients who slept less than 5 hours a day, the group of patients who slept 6–7hours had higher HGS, whereas the group of patients who slept more than 9 hours had weaker HGS. This trend was more apparent in the elderlypopulation. @*Conclusion@#This study of the adult population of South Korea suggests that sleeping for approximately 6 to 7 h a day increases muscle strength andgeneral well-being, whereas extreme sleep durations, such as less than 5 h or more than 9 h, result in weaker muscle strength, in general.

Central serous chorioretinopathy associated with low dose systemic corticosteroid treatment of Behcet's disease / 영남의대학술지

Central serous chorioretinopathy may induce poor eyesight and serous retinal detachment. However, its exact cause has not been well established thus far. It can be associated with systemic high-dose corticosteroid treatment mainly for young and middle-aged men and may spontaneously regress or recur after withdrawal from corticosteroid. After corticosteroid administration for Behcet's disease, it is necessary to identify any ocular symptoms. Behcet's disease can lead to the development of ocular complications, such as uveitis, hypopyon, retinal vasculitis, optic neuritis, angiogenesis, secondary cataract, and glaucoma. It is possible to diagnose any of these complications via optical coherence tomography and digital indocyanine green angiography. It is easy to neglect an ocular symptom that may appear after a low-dose corticosteroid treatment as an ocular complication in patients with Behcet's disease. Thus, we report on a case concerning high-dose corticosteroid treatment with a literature review.

D-dimer Predicts Short-Term Functional Outcome in Acute Ischemic Stroke

BACKGROUND: The objective of the study was to evaluate the predictive value of plasma D-dimer at admission after acute ischemic stroke, and to assess its effect on short-term functional outcome. METHODS: Fasting plasma D-dimer was measured in 290 consecutive patients (61.7% men, mean age 67.0±12.3 years) within 3 days after the onset of acute ischemic stroke. The outcomes were measured at 3-months after stroke onset, by the modified Rankin Scale (mRS). RESULTS: Atrial fibrillation, hypertension, diabetes and involvement of the insular cortex, the levels of serum high sensitive C-reactive protein and D-dimer, as well as incidence of women and age, were all significantly higher in the poor outcome group (P<0.05). After the adjustment of National Institutes of Health Stroke Scale (NIHSS) scores on admission, the plasma D-dimer levels positively correlated with mRS (Spearman partial rho=0.247, P<0.001). The cut-off value of D-dimer level for prediction of poor outcomes was 0.35 mg/L (sensitivity 0.70, specificity 0.63, area under the curve 0.71). Furthermore, two multivariated logistic regression analysis models were performed. One model excluded the NIHSS score as an independent variable, and demonstrated that D-dimer (odds ratio, 1.24 for every 1.0 mg/L, P<0.05) was independently associated with poor functional outcome. Conversely, the other model which included the NIHSS score, did not show any such association. CONCLUSIONS: Plasma D-dimer level is a useful marker for short-term outcomes in acute ischemic stroke, and may have a role in risk stratification for predicting a poor outcome.

Central serous chorioretinopathy associated with low dose systemic corticosteroid treatment of Behcet's disease / 영남의대학술지

Central serous chorioretinopathy may induce poor eyesight and serous retinal detachment. However, its exact cause has not been well established thus far. It can be associated with systemic high-dose corticosteroid treatment mainly for young and middle-aged men and may spontaneously regress or recur after withdrawal from corticosteroid. After corticosteroid administration for Behcet's disease, it is necessary to identify any ocular symptoms. Behcet's disease can lead to the development of ocular complications, such as uveitis, hypopyon, retinal vasculitis, optic neuritis, angiogenesis, secondary cataract, and glaucoma. It is possible to diagnose any of these complications via optical coherence tomography and digital indocyanine green angiography. It is easy to neglect an ocular symptom that may appear after a low-dose corticosteroid treatment as an ocular complication in patients with Behcet's disease. Thus, we report on a case concerning high-dose corticosteroid treatment with a literature review.

The maintenance ability and Ca²⁺ availability of skeletal muscle are enhanced by sildenafil

Sildenafil relaxes vascular smooth muscle cells and is used to treat pulmonary artery hypertension as well as erectile dysfunction. However, the effectiveness of sildenafil on skeletal muscle and the benefit of its clinical use have been controversial, and most studies focus primarily on tissues and organs from disease models without cellular examination. Here, the effects of sildenafil on skeletal muscle at the cellular level were examined using mouse primary skeletal myoblasts (the proliferative form of skeletal muscle stem cells) and myotubes, along with single-cell Ca2+ imaging experiments and cellular and biochemical studies. The proliferation of skeletal myoblasts was enhanced by sildenafil in a dose-independent manner. In skeletal myotubes, sildenafil enhanced the activity of ryanodine receptor 1, an internal Ca2+ channel, and Ca2+ movement that promotes skeletal muscle contraction, possibly due to an increase in the resting cytosolic Ca2+ level and a unique microscopic shape in the myotube membranes. Therefore, these results suggest that the maintenance ability of skeletal muscle mass and the contractility of skeletal muscle could be improved by sildenafil by enhancing the proliferation of skeletal myoblasts and increasing the Ca2+ availability of skeletal myotubes, respectively.

Subcutaneous tissue calcification in a patient with rheumatoid arthritis / 영남의대학술지

Subcutaneous tissue calcification in rheumatic diseases usually occurs in connective tissue diseases, such as systemic lupus erythematosus, scleroderma, and dermatomyositis. Domestic cases of calcification in rheumatoid arthritis have not been reported. The mechanism of subcutaneous tissue calcification may differ depending on the cause and it can develop on all parts of the body. Calcification occurring in rheumatic diseases is a major mechanism of tissue damage caused by chronic inflammation. No standard therapy for calcification has been established; however, many studies have reported on medical and surgical treatment. We report on subcutaneous tissue calcification in a rheumatoid arthritis patient tissue calcification on both sides of the buttocks, the upper limbs, and the lower limbs.

Clinical Implications of Functional Tricuspid Regurgitation and Optimal Surgical Timing / 대한내과학회지

Optimal surgical timing is of crucial importance for the treatment of valvular heart diseases. Clinical implications of functional tricuspid regurgitation (TR) are increasingly being recognized. In contrast to the well-established treatment strategies for left-sided valve disease, optimal surgical timing of functional TR has not yet been established. Several lines of evidence have accumulated over the past 10 years, and now is the perfect time to review the data. The present article reviews the clinical implications and treatment strategies of functional TR, particularly in relation to optimal surgical timing.

Dental treatment of a patient with long QT syndrome under moderate sedation with target-controlled infusion of propofol

Long QT syndrome (LQTs) is a rare congenital disorder of the heart's electrical activity. Patients with LQTs are at increased risk of developing fatal ventricular arrhythmias. Elevated levels of sympathetic stimulation can exacerbate this risk. Successful behavior management is indispensable in the treatment of patients with LQTs. However, many drugs involved in pharmacologic behavior management are known to adversely affect the QT interval. Therefore, careful selection of a sedative drug is essential in avoiding such incidences. A 10-year-old boy with a known diagnosis of LQTs required restorative treatment due to dental caries at the permanent molar. He required sedation since treatment was painful and dental phobia can trigger sympathetic stimulation, creating a dangerous situation for patients with LQTs. Therefore, the treatment was performed over two sessions under moderate sedation involving propofol combined with nitrous oxide. Restorative treatment was successful without any complications under sedation with a target-controlled infusion (TCI) of propofol. There was no significant QT prolongation during pulpal treatment. Propofol TCI may be a good candidate for sedation in patients with LQTs.

Dental treatment of a patient with long QT syndrome under moderate sedation with target-controlled infusion of propofol

Long QT syndrome (LQTs) is a rare congenital disorder of the heart's electrical activity. Patients with LQTs are at increased risk of developing fatal ventricular arrhythmias. Elevated levels of sympathetic stimulation can exacerbate this risk. Successful behavior management is indispensable in the treatment of patients with LQTs. However, many drugs involved in pharmacologic behavior management are known to adversely affect the QT interval. Therefore, careful selection of a sedative drug is essential in avoiding such incidences. A 10-year-old boy with a known diagnosis of LQTs required restorative treatment due to dental caries at the permanent molar. He required sedation since treatment was painful and dental phobia can trigger sympathetic stimulation, creating a dangerous situation for patients with LQTs. Therefore, the treatment was performed over two sessions under moderate sedation involving propofol combined with nitrous oxide. Restorative treatment was successful without any complications under sedation with a target-controlled infusion (TCI) of propofol. There was no significant QT prolongation during pulpal treatment. Propofol TCI may be a good candidate for sedation in patients with LQTs.

The diagnostic utility of chest computed tomography scoring for the assessment of amiodarone-induced pulmonary toxicity

BACKGROUND/AIMS: Amiodarone is one of the most widely used antiarrhythmic agents; however, amiodarone-induced pulmonary toxicity (APT) can be irreversible and sometimes fatal. The aim of this study was to evaluate the feasibility of chest computed tomography (CT) as a diagnostic tool for APT and to assess the utility of the CT APT score as an index for predicting the severity of APT. METHODS: Patients underwent amiodarone treatment for various reasons, most often atrial fibrillation, for more than 2 years, and those that received a cumulative dose > 100 g were enrolled. A total of 34 patients who underwent chest CT between December 2011 and June 2012 were enrolled, whether or not they had clinical symptoms. The APT CT score was defined as the number of involved regions in the lung, which was divided into 18 regions (right and left, upper, middle, and lower, and central, middle, and peripheral). The CT findings were evaluated according to the total dose and duration of amiodarone treatment and the results of a pulmonary function test. Clinical symptoms and outcomes were also evaluated according to APT CT scores. RESULTS: Seven patients had positive APT CT scores (interstitial fibrosis in five, organizing pneumonia in one, and mixed interstitial fibrosis and organizing pneumonia in one), and these patients exhibited significantly lower diffusion capacity for carbon monoxide in the lungs compared with patients without an increased APT CT score (70.2% +/- 6.9% vs. 89.7% +/- 19.4%; p = 0.011). Three of the seven patients experienced overt APT that required hospital admission. CONCLUSIONS: Chest CT is a useful diagnostic tool for APT, and the APT CT score might be a useful index for assessing the severity of APT.

Pes anserinus and anserine bursa: anatomical study / 대한해부학회지

This study investigated the boundary of anserine bursa with the recommended injection site and shape on the insertion area of pes anserinus (PA), with the aim of improving clinical practice. Eighty six legs from 45 Korean cadavers were investigated. The mixed gelatin solution was injected to identify the shape of anserine bursa, and then the insertion site of the PA tendons was exposed completely and carefully dissected to identify the shape of the PA. The sartorius was inserted into the superficial layer and gracilis, and the semitendinosus was inserted into the deep layer on the medial surface of the tibia. The number of the semitendinosus tendons at the insertion site varied: 1 in 66% of specimens, 2 in 31%, and 3 in 3%. The gracilis and semitendinosus tendons were connected to the deep fascia of leg. Overall, the shape of the anserine bursa was irregularly circular. Most of the anserine bursa specimens reached the proximal line of the tibia, and some of the specimens reached above the proximal line of the tibia. In the medial view of the tibia, the anserine bursa was located posteriorly and superiorly from the tibia's midline, and it followed the lines of the sartorius muscle. The injection site for anserine bursa should be carried out at 20degrees from the vertical line medially and inferiorly, 15 or 20 mm deeply, and at the point of about 20 mm medial and 12 mm superior from inferomedial point of tibial tuberosity.

Pes anserinus and anserine bursa: anatomical study / 대한해부학회지

This study investigated the boundary of anserine bursa with the recommended injection site and shape on the insertion area of pes anserinus (PA), with the aim of improving clinical practice. Eighty six legs from 45 Korean cadavers were investigated. The mixed gelatin solution was injected to identify the shape of anserine bursa, and then the insertion site of the PA tendons was exposed completely and carefully dissected to identify the shape of the PA. The sartorius was inserted into the superficial layer and gracilis, and the semitendinosus was inserted into the deep layer on the medial surface of the tibia. The number of the semitendinosus tendons at the insertion site varied: 1 in 66% of specimens, 2 in 31%, and 3 in 3%. The gracilis and semitendinosus tendons were connected to the deep fascia of leg. Overall, the shape of the anserine bursa was irregularly circular. Most of the anserine bursa specimens reached the proximal line of the tibia, and some of the specimens reached above the proximal line of the tibia. In the medial view of the tibia, the anserine bursa was located posteriorly and superiorly from the tibia's midline, and it followed the lines of the sartorius muscle. The injection site for anserine bursa should be carried out at 20degrees from the vertical line medially and inferiorly, 15 or 20 mm deeply, and at the point of about 20 mm medial and 12 mm superior from inferomedial point of tibial tuberosity.

Is propofol safe when administered to cirrhotic patients during sedative endoscopy?

BACKGROUND/AIMS: In patients with liver cirrhosis, drugs acting on the central nervous system can lead to hepatic encephalopathy and the effects may be prolonged. Recently, misuse of propofol has been reported and the associated risk of death have become an issue. Propofol is commonly used during sedative endoscopy; therefore, its safety in high-risk groups must be further investigated. We performed a pilot study of the safety and efficacy of propofol during endoscopy in Korean patients with cirrhosis. METHODS: Upper gastrointestinal endoscopy was performed under sedation with propofol along with careful monitoring in 20 patients with liver cirrhosis and 20 control subjects. The presence or development of hepatic encephalopathy was assessed using the number connection test and neurologic examination. RESULTS: Neither respiratory depression nor clinically significant hypotension were observed. Immediate postanesthetic recovery at 5 and 10 minutes after the procedure was delayed in the cirrhotic patients compared with the control group; however, at 30 minutes, the postanesthetic recovery was similar in both groups. Baseline psychomotor performance was more impaired in cirrhotic patients, but propofol was not associated with deteriorated psychomotor function even in cirrhotic patients with a minimal hepatic encephalopathy. CONCLUSIONS: Sedation with propofol was well tolerated in cirrhotic patients. No newly developed hepatic encephalopathy was observed.

Paradoxical Cerebral Embolism Associated With Isolated Pulmonary Arteriovenous Fistula

No abstract available.

Molar Tooth Sign in Joubert Syndrome

No abstract available.

The Differences of Left Ventricular Geometry in Acute Myocardial Infarction and the Effects on Short Term Mortality / 이화의대지

OBJECTIVES: This study designed to find the differences of left ventricular (LV) geometry in acute myocardial infarction (AMI) between ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) and the occurrences of adverse outcome according to the LV geometry. METHODS: Comprehensive echocardiographic analyses were performed in 256 patients with AMI. The left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. LV geometry were classified into 4 groups based on RWT and LVMI: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LV geometry and clinical outcomes. RESULTS: Patients with NSTEMI were more likely to have diabetes mellitus, hypertension, heart failure, stroke and previous myocardial infarction. By the geometric type, patients with NSTEMI were more likely to have eccentric hypertrophy (n=51, 34.7% vs. n=24, 22.0%, P=0.028). There was no significantly different adverse outcome between STEMI and NSTEMI patients. Fifteen patients (5.9%, 7 female [46.7%]) died and the median duration of survival was 10 days (range, 1 to 386 days). Concentric hypertrophy carried the greatest risk of all cause mortality (hazard ratios, 5.83; 95% confidence interval, 1.04 to 32.7). CONCLUSION: NSTEMI patients had more likely to have eccentric hypertrophy but adverse outcome after AMI was not different between STEMI and NSTEMI patients. Concentric hypertrophy had the greatest risk of short term mortality.

Efficacy of a commercial live attenuated Lawsonia intracellularis vaccine in a large scale field trial in Korea

PURPOSE: Porcine proliferative enteropathy (PPE) is known as one of the most important risk factors causing economic losses in swine industry worldwide. This study was conducted to evaluate the efficacy of a commercial oral attenuated Lawsonia intracellularis vaccine (Enterisol Ileitis) against PPE under a commercial pig farm condition in Korea. MATERIALS AND METHODS: Thirty two-day-old 672 piglets were randomly allocated into vaccinated and control groups. All piglets in the vaccinated group were inoculated with a commercial attenuated L. intracellularis vaccine as following the manufacturer's instruction. Body weights of all pigs in both groups were measured on the vaccination day and 6, 14, and 20 weeks post vaccination and an average daily weight gain (ADWG) was calculated. Health status was observed biweekly during the whole trial. RESULTS: The vaccinated group showed significantly higher body weight (p<0.05) and ADWG (p<0.05) than those of the control group. The vaccinated group had significantly reduced impairments in activity, growth, defecation frequency, and stool hardness (p<0.05). Additional health benefits and improved weight gain by the vaccination produced a 4.2:1 return of investment, and the higher gross margin was $4.80 per pig. CONCLUSION: Our finding suggests that the L. intracellularis vaccine program has effects on the substantial health and economic benefits in the Korean swine industry.

Cough-Induced Syncope in a Patient with Bronchial Asthma

Cough-induced syncope is belongs to the heterogeneous group of situational syncope. It is characterized by the loss of consciousness occurring after excessive coughing. A 63-year-old man complained of cough syncope for 15 days. During vigorous coughing, he lost consciousness for a few seconds. He had past medical history of bronchial asthma and diabetes mellitus. Various tests for syncope including electroencephalogram, electrocardiogram, 24-hours Holter monitoring, echocardiogram, carotid sinus massage, tilt table test, carotid duplex, and brain MRI were normal. He was treated successfully with anti-tussives and bronchodilators. We report a case of cough-induced syncope in a patient with bronchial asthma.

Atypical Sturge-Weber Syndrome Presenting with Stroke-Like Episode

Sturge-Weber syndrome (SWS) is a rare sporadic neurocutaneous syndrome, characterized by port-wine nevus of face, ocular vascular abnormalities and leptomeningeal angioma. A 63-year-old man developed sudden onset of right hemiparesis and global aphasia. He had a past history of epilepsy. Physical examination showed no skin lesions. Brain CT demonstrated gyriform calcification in the left frontal area. Brain MRI revealed cortical atrophy in the left hemisphere with no diffusion restrictions. Fourteen hours later, he was completely recovered from aphasia and motor weakness. We report a case of atypical SWS with episode of acute hemiparesis which highlight the difficulty in distinguishing seizure from ischemic symptoms.