The Influence of Leadership Life Skills and Achievement Motivation on Self-leadership in Nursing Students / 간호행정학회지

PURPOSE: Nursing students are expected to show self-leadership. For this study, leadership life skills and achievement motivation were examined for their influence on self-leadership in student nurses. METHODS: A descriptive study was conducted using a self-report questionnaire completed by 239 nursing students. Data were analyzed using t-test, one way ANOVA, Scheffé test, Pearson correlation coefficients, and stepwise multiple regression analysis with SPSS 20.0 program. RESULTS: The mean score for self-leadership was 3.49, for leadership life skills, 3.65, and for achievement motivation, 3.42. There were significant differences in self-leadership according to task orientation (β=.25, p < .001), responsibility (β=.24, p < .001), challenge spirit (β=.22 p < .001), future orientation (β=.16, p=.001), leadership life skills (β=.08, p=.009), and interpersonal relationships (β=−.09, p < .001). The explanation power of the regression model was 51.1% and it was statistically significant (F=41.87, p < .001). CONCLUSION: The results of this study show that factors influencing self-leadership are leadership life skills and achievement motivation. Therefore, it is necessary to develop intervention programs to improve self-leadership in nursing students for enhancement of task orientation, responsibility, challenge spirit, future orientation, and leadership life skills.

Development and validation of a Lao Juan questionnaire / 中国结合医学杂志

<p><b>OBJECTIVES</b>Lao Juan (LJ, ) is a syndrome described in Chinese medicine (CM) that manifests with fatigue, fever, spontaneous sweating, indigestion, work-induced pain, weakness of the limbs, and shortness of breath. The present study was conducted to examine the reliability and validity of a Lao Juan Questionnaire (LJQ).</p><p><b>METHODS</b>A total of 151 outpatients and 73 normal subjects were asked to complete the LJQ. Seventy-three normal subjects were additionally asked to complete the Chalder Fatigue Scale (CFS). Twelve clinicians determined whether the 151 outpatients exhibited LJ or not. The internal consistency and construct validity for the LJQ were estimated using data from the outpatient subjects. The CFS data were used to examine the concurrent validity of the LJQ. Total LJQ scores and the clinicians᾿diagnoses of the outpatients were used to perform receiver operating characteristics (ROC) curve analyses and to define an optimum cut-off score for the LJQ.</p><p><b>RESULTS</b>The 19-item LJQ had satisfactory internal consistency (α=0.828) and concurrent validity, with significant correlations between the LJQ and the CFS subscales. In the test of construct validity using principal component analysis, a total of six factors were extracted, and the overall variance explained by all factors was 59.5%. In ROC curve analyses, the sensitivity, specificity, and area under the curve were 76.0%, 59.2%, and 0.709, respectively. The optimum cut-off score was defined as six points.</p><p><b>CONCLUSIONS</b>Our results suggest that the LJQ is a reliable and valid instrument for evaluating LJ.</p>

Relationships between pathological patterns and vocal qualities estimated by acoustic parameters / 中国结合医学杂志

<p><b>OBJECTIVE</b>To examine whether vocal characteristics estimated by acoustic parameters were associated with phlegm, yin deficiency, or cold-heat patterns.</p><p><b>METHODS</b>A total of 75 college students (males:females = 53:22) aged 19-24 years were enrolled in this study. Each subject was asked to complete the phlegm pattern questionnaire (PPQ), yin deficiency questionnaire (YDQ) and cold-heat questionnaire (CHQ). For the acoustic analysis, each subject was asked to produce a sustained vowel sound (/a/) for 3 s to be used to calculate acoustic parameters. Then, habitual fundamental frequency (F0), jitter, shimmer, F0tremor, mean F0, standard deviation of F0, maximum F0, minimum F0, normalized noise energy, harmonic-to-noise ratio, signal-to-noise ratio, amplitude tremor, and power ratio were calculated using the Dr. Speech software. Finally, four hierarchical regression models with pattern questionnaire scores as dependent variables were formed to examine which factors among acoustic parameters, sex, and age were predictive of those pattern scores.</p><p><b>RESULTS</b>PPQ, YDQ, heat, and cold pattern scores all formed significant regression model equations and the adjusted R2 values were 0.281, 0.164, 0.156, and 0.170, respectively. There were aging effects in the PPQ and YDQ models (standardized β=0.199, 0.271, respectively). Vocal tremor-related F0 tremor and vocal ringing-related power ratio parameters were associated with PPQ and YDQ scores. Gender was directly predictive of PPQ and indirectly moderated the relationship between power ratio and YDQ score. Vocal pitch-related habitual F0 and mean F0 were associated with heat and cold scores. These results indicate that the vocal qualities of phlegm- and yin deficiency-susceptible subjects tend to be ringing and less tremorous, and those of heat- and cold-susceptible subjects tend to be high-pitched.</p><p><b>CONCLUSION</b>Our study results suggest that vocal characteristics estimated by acoustic parameters are partially predictive of phlegm, yin deficiency, heat, and cold patterns. In terms of phlegm and yin deficiency patterns, there were direct or moderating effects of sex and age.</p>

PPARgamma modulates vascular smooth muscle cell phenotype via a protein kinase G-dependent pathway and reduces neointimal hyperplasia after vascular injury

Vascular smooth muscle cells (VSMCs) undergo phenotypic changes in response to vascular injury such as angioplasty. Protein kinase G (PKG) has an important role in the process of VSMC phenotype switching. In this study, we examined whether rosiglitazone, a peroxisome proliferator-activated receptor (PPAR)-gamma agonist, could modulate VSMC phenotype through the PKG pathway to reduce neointimal hyperplasia after angioplasty. In vitro experiments showed that rosiglitazone inhibited the phenotype change of VSMCs from a contractile to a synthetic form. The platelet-derived growth factor (PDGF)-induced reduction of PKG level was reversed by rosiglitazone treatment, resulting in increased PKG activity. This increased activity of PKG resulted in phosphorylation of vasodilator-stimulated phosphoprotein at serine 239, leading to inhibited proliferation of VSMCs. Interestingly, rosiglitazone did not change the level of nitric oxide (NO) or cyclic guanosine monophosphate (cGMP), which are upstream of PKG, suggesting that rosiglitazone influences PKG itself. Chromatin immunoprecipitation assays for the PKG promoter showed that the activation of PKG by rosiglitazone was mediated by the increased binding of Sp1 on the promoter region of PKG. In vivo experiments showed that rosiglitazone significantly inhibited neointimal formation after balloon injury. Immunohistochemistry staining for calponin and thrombospondin showed that this effect of rosiglitazone was mediated by modulating VSMC phenotype. Our findings demonstrate that rosiglitazone is a potent modulator of VSMC phenotype, which is regulated by PKG. This activation of PKG by rosiglitazone results in reduced neointimal hyperplasia after angioplasty. These results provide important mechanistic insight into the cardiovascular-protective effect of PPARgamma.

A Case of Cardiac Beriberi: A Forgotten but Memorable Disease

Thiamine (vitamin B1) serves as an important cofactor in body metabolism and energy production. It is related with the biosynthesis of neurotransmitters and the production of substances used in defense against oxidant stress. Thus, a lack of thiamine affects several organ systems, in particular the cardiovascular and nervous system. The cardiac insufficiency caused by thiamine deficiency is known as cardiac beriberi, with this condition resulting from unbalanced nutrition and chronic excessive alcohol intake. Given that the disease is now very rare in developed nations such as Korea, it is frequently missed by cardiologists, with potentially fatal consequences. Herein, we present a case study in order to draw attention to cardiac beriberi. We believe that this case will be helpful for young cardiologists, reminding them of the importance of this forgotten but memorable disease.

Magnetic Bionanoparticle Enhances Homing of Endothelial Progenitor Cells in Mouse Hindlimb Ischemia

BACKGROUND AND OBJECTIVES: Poor homing efficiency is one of the major limitations of current stem cell therapy. Magnetic bionanoparticles (MPs) obtained from Magnetospirillum sp. AMB-1 have a lipid bilayer membrane and ferromagnetic properties. We evaluated a novel priming strategy using MPs to enhance the homing of transplanted progenitor cells to target tissue. MATERIALS AND METHODS: Effects of MP on proliferation, viability, and migration of late human endothelial progenitor cells (EPCs) were examined in vitro. Additionally, effects of MP on gene and protein expression related to survival and adhesion were evaluated. Homing and angiogenic efficiency of MP transferred late EPCs was evaluated in nude mouse hindlimb ischemia model. RESULTS: Below threshold concentration, MP transfer did not influence proliferation or survival of late EPCs, but enhanced migration and trans-endothelial migration of late EPCs toward magnet. Below threshold concentration, MP transfer did not influence gene and protein expression related to survival. In the mouse hindlimb ischemia model, late EPCs treated with high dose MP (5 ug/mL) showed enhanced homing of injected late EPCs in the ischemic limb by magnet, compared to low dose MP (1 ug/mL) treated late EPCs. In addition, high dose MP transferred EPC showed significantly better improvement of perfusion in ischemic limb compared to untreated EPC. CONCLUSION: MP transfer with magnet application can be a promising novel strategy to enhance homing efficacy and outcomes of current stem cell therapy.

Clinical application of stem cell in cardiovascular diseases

Cardiovascular disease has been one of leading causes of death and has an increasing importance in Korea. However the current treatment modalities for cardiovascular disease have limited efficacy. To overcome the limitations of current therapies, stem cell therapy has been evaluated as a new therapeutic option. Most experience and achievements of stem cell therapy for clinical applications have come from bone marrow-derived stem cells. Recent meta-analyses showed that stem cell therapy is safe and effective for improving cardiac systolic functions in patients with acute myocardial infarction. However, the long term efficacy and effects on clinical outcomes need to be determined. Stem cell therapy for acute cardiovascular disease, especially for acute myocardial infarction, has a proven efficacy and safety in short term follow up. Newer stem cell sources and therapeutic approaches such as adjunctive therapy or pretransplantation cultivation will be applied in this field to improve the efficacy of stem cell therapy. Stem cell therapy is a promising new therapeutic option for cardiovascular disease.

Survival, Exercise Capacity, and Left Ventricular Remodeling in a Rat Model of Chronic Mitral Regurgitation: Serial Echocardiography and Pressure-Volume Analysis

BACKGROUND AND OBJECTIVES: The aims of this study were to establish a reliable model of chronic mitral regurgitation (MR) in rats and verify the pathophysiological features of this model by evaluating cardiac function using serial echocardiography and a pressure-volume analysis. MATERIALS AND METHODS: MR was created in 37 Sprague-Dawley rats by making a hole with a 23 gauge needle on the mitral leaflet through the left ventricular (LV) apex under the guidance of transesophageal echocardiography. RESULTS: Serial echocardiograms revealed that the LV began to dilate immediately after the MR operation and showed progressive dilation until the 14th week (LV end-systolic dimension at 14 weeks, 4.71+/-0.25 mm vs. 6.81+/-0.50 mm for sham vs. MR, p<0.01; LV end-diastolic dimension, 8.32+/-0.42 mm vs. 11.01+/-0.47 mm, p<0.01). The LV ejection fraction tended to increase immediately after the MR operation but started to decrease thereafter and showed a significant difference with the sham group from the 14th week (70.0+/-2.2% vs. 62.1+/-3.1% for sham vs. MR). In a pressure-volume analysis performed at the 14th week, the LV end-systolic pressure-volume relationship and +dp/dt decreased significantly in the MR group. A serial treadmill test revealed that exercise capacity remained in the normal range until the 14th week when it began to decrease (exercise duration, 406+/-45 seconds vs. 330+/-27 seconds, p<0.01). A pathological analysis showed no significance difference in interstitial fibrosis between the two groups. CONCLUSION: We established a small animal model of chronic MR and verified its pathophysiological features. This model may provide a useful tool for future research on MR and volume overload heart failure.

Evaluation of Local Flow Conditions in Jailed Side Branch Lesions Using Computational Fluid Dynamics

BACKGROUND AND OBJECTIVES: Lesions of vascular bifurcation and their treatment outcomes have been evaluated by anatomical and physiological methods, such as intravascular ultrasound and fractional flow reserve (FFR). However, local changes in flow dynamics in lesions of bifurcation have not been well evaluated. This study aimed at evaluating changes in the local flow patterns of bifurcation lesions. MATERIALS AND METHODS: Eight (n=8) representative simulation-models were constructed: 1 normal bifurcation, 5 main-branch (MB) stenting models with various side-branch (SB) stenoses (ostial or non-ostial 75% diameter stenosis with 1- or 2-cm lesion lengths, ostial 75% diameter stenosis caused by carina shift), and 2 post-kissing models (no or 50% SB residual stenosis). Pressure, velocity, and wall shear stress (WSS) profiles around the bifurcation sites were investigated using computational fluid dynamics. RESULTS: Post-stenting models revealed significant pressure drop in the SB (FFR<0.75), excluding the carina shift model (FFR=0.89). In the post-kissing models, there was no significant pressure drop. All post-stenting models revealed eccentric low velocity flow patterns and areas of low WSS, primarily in the lateral wall on distal MB. Post-kissing angioplasty improved pressure drop in the SB but resulted in alteration of flow distribution in the MB. In the carina shift model, kissing ballooning resulted in deteriorated local flow conditions due to increased area of low velocity and WSS. CONCLUSION: This study suggests that the most commonly used bifurcation intervention strategy may cause local flow disturbances, which may partially explain high restenosis and event rates in patients with bifurcation lesions.

Evaluation of Local Flow Conditions in Jailed Side Branch Lesions Using Computational Fluid Dynamics

BACKGROUND AND OBJECTIVES: Lesions of vascular bifurcation and their treatment outcomes have been evaluated by anatomical and physiological methods, such as intravascular ultrasound and fractional flow reserve (FFR). However, local changes in flow dynamics in lesions of bifurcation have not been well evaluated. This study aimed at evaluating changes in the local flow patterns of bifurcation lesions. MATERIALS AND METHODS: Eight (n=8) representative simulation-models were constructed: 1 normal bifurcation, 5 main-branch (MB) stenting models with various side-branch (SB) stenoses (ostial or non-ostial 75% diameter stenosis with 1- or 2-cm lesion lengths, ostial 75% diameter stenosis caused by carina shift), and 2 post-kissing models (no or 50% SB residual stenosis). Pressure, velocity, and wall shear stress (WSS) profiles around the bifurcation sites were investigated using computational fluid dynamics. RESULTS: Post-stenting models revealed significant pressure drop in the SB (FFR<0.75), excluding the carina shift model (FFR=0.89). In the post-kissing models, there was no significant pressure drop. All post-stenting models revealed eccentric low velocity flow patterns and areas of low WSS, primarily in the lateral wall on distal MB. Post-kissing angioplasty improved pressure drop in the SB but resulted in alteration of flow distribution in the MB. In the carina shift model, kissing ballooning resulted in deteriorated local flow conditions due to increased area of low velocity and WSS. CONCLUSION: This study suggests that the most commonly used bifurcation intervention strategy may cause local flow disturbances, which may partially explain high restenosis and event rates in patients with bifurcation lesions.

Clinical Characteristics of Coronary Drug-Eluting Stent Fracture: Insights from a Two-Center DES Registry

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.

Clinical Characteristics of Coronary Drug-Eluting Stent Fracture: Insights from a Two-Center DES Registry

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.

HMG-CoA Reductase Inhibitor Improves Endothelial Dysfunction in Spontaneous Hypertensive Rats Via Down-regulation of Caveolin-1 and Activation of Endothelial Nitric Oxide Synthase

Hypertension is associated with endothelial dysfunction and increased cardiovascular risk. Caveolin-1 regulates nitric oxide (NO) signaling by modulating endothelial nitric oxide synthase (eNOS). The purpose of this study was to examine whether HMG-CoA reductase inhibitor improves impaired endothelial function of the aorta in spontaneous hypertensive rat (SHR) and to determine the underlying mechanisms involved. Eight-week-old male SHR were assigned to either a control group (CON, n=11) or a rosuvastatin group (ROS, n=12), rosuvastatin (10 mg/kg/day) administered for eight weeks. Abdominal aortic rings were prepared and responses to acetylcholine (10-9-10-4 M) were determined in vitro. To evaluate the potential role of NO and caveolin-1, we examined the plasma activity of NOx, eNOS, phosphorylated-eNOS and expression of caveolin-1. The relaxation in response to acetylcholine was significantly enhanced in ROS compared to CON. Expression of eNOS RNA was unchanged, whereas NOx level and phosphorylated-eNOS at serine-1177 was increased accompanied with depressed level of caveolin-1 in ROS. We conclude that 3-Hydroxy-3-methylglutaryl Coenzyme-A (HMG-CoA) reductase inhibitor can improve impaired endothelial dysfunction in SHR, and its underlying mechanisms are associated with increased NO production. Furthermore, HMG-CoA reductase inhibitor can activate the eNOS by phosphorylation related to decreased caveolin-1 abundance. These results imply the therapeutic strategies for the high blood pressure-associated endothelial dysfunction through modifying caveolin status.

Clinical and Radiographic Features of Adult-onset Ankylosing Spondylitis in Korean Patients: Comparisons between Males and Females

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.

Normal Ranges and Physiological Changes of Midwall Fractional Shortening in Healthy Korean Population

BACKGROUND AND OBJECTIVES: Left ventricular (LV) midwall fractional shortening (FSmw) reflects systolic function more accurately than LV endocardial fractional shortening (eFS) in patients with increased LV wall thickness. Although the normal reference ranges of LV-FSmw have been suggested in Western population studies, its reference values and age-related physiological changes in Eastern populations remain unknown. SUBJECTS AND METHODS: Conventional echocardiographic parameters, LV-FSmw, and stress-corrected LV-FSmw were assessed in 160 healthy and clinically normal subjects with a mean age of 45 (range, 11-72 years; 104 males, 56 women), all of whom were confirmed to be free of disease, based on laboratory investigations, clinical and physical examination findings and computed tomographic coronary angiographic examinations. RESULTS: LV-FSmw was higher in women compared to men. However, the differences were without statistical significance (18.2+/-1.5% for male gender and 19.4+/-2.5% for female gender, p=0.07). In contrast to LV-eFS that progressively increased with age (p=0.001), LV-FSmw and stress-corrected LV-FSmw was not influenced by changes in age (p=0.88 and 0.29, respectively). The results remained unchanged when analyses were performed adjusting for gender. CONCLUSION: The results of this study provide normal reference values for LV-FSmw and stress-corrected LV-FSmw and their natural physiological changes with advancing age. These measures can be used as reference standards for research on LV systolic function in the setting of pressure or volume overload.

A Giant Left Atrium in Rheumatic Mitral Stenosis

Enlargement of left atrium (LA) is not infrequently observed in patients with rheumatic mitral stenosis. We recently met a patient who had a giant LA associated with severe mitral stenosis. The right ventricle had almost collapsed due to compression by the LA. Mitral valve surgery was performed for mitral stenosis and the postoperative course was uneventful. Thus, we suggest that clinicians should not delay corrective surgery for severe mitral stenosis solely on account of a huge LA.

Usefulness of Mitral Annulus Velocity for the Early Detection of Left Ventricular Dysfunction in a Rat Model of Diabetic Cardiomyopathy

BACKGROUND: Diabetic cardiomyopathy (DMCMP) is characterized by myocardial dysfunction regardless of coronary artery disease in diabetic patients. The features of LV dysfunction in rat model of type 1 DM induced by streptozocin, are variable and controversial. Thus, we tested the usefulness of tissue Doppler imaging in the early detection of ventricular dysfunction in a rat model of DMCMP. METHODS: Diabetes was induced by intra-peritoneal injection of streptozocin (70 mg/kg) in 8 weeks of Sprague-Dawley rat. Diagnosis of diabetes was defined as venous glucose level over 350 mg/dL 48 hrs after streptozocin injection. Echocardiography was done at baseline and 10 weeks after diabetes induction both in diabetes group (n=15) and normal control (n=10). After echocardiography at 10 weeks, invasive hemodynamic measurement using miniaturized conductance catheter was done in both groups. RESULTS: Ten weeks after diabetes induction, heart and lung mass indexes of diabetes were larger than those of normal control (3.2+/-0.3 vs. 2.4+/-0.2 mg/g, p<0.001, 5.5+/-1.1 vs. 3.6+/-0.6 mg/g, p<0.001, respectively). In echocardiographic data, s' (2.4+/-0.4 vs. 3.1+/-0.5 cm/s, p<0.001), e' velocity of mitral annulus (2.9+/-0.6 vs. 3.8+/-1.1 cm/s, p<0.001), and E/e' ratio (27.1+/-5.6 vs. 19.7+/-2.6, p<0.001) were impaired in diabetes group. In hemodynamic measurement, there were no differences in ejection fraction, peak dP/dt between the diabetic group and normal control. However, load independent indexes of contractility, the slope of the end-systolic pressure volume relation (0.18+/-0.07 vs. 0.62+/-0.18 mmHg/microL, p<0.001) and preload recruitable stroke work (51.8+/-22.0 vs. 90.9+/-22.5 mmHg, p<0.001) were impaired in diabetic group compared to normal control. CONCLUSION: In a rat model of diabetic cardiomyopathy, tissue Doppler imaging of mitral annulus can be a good modality for early detection of myocardial dysfunction.

B-Type Natriuretic Peptide in Isolated Severe Tricuspid Regurgitation: Determinants and Impact on Outcome

BACKGROUND: The plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in heart failure and valvular heart disease. In patients with isolated severe tricuspid regurgitation (TR), little is known about the determinants of plasma BNP levels and the correlation with future outcome. The purpose of this study was to identify the determinants of plasma BNP levels in patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective surgery. METHODS: We prospectively enrolled 39 patients with isolated, severe TR undergoing corrective surgery. A plasma BNP assay and cardiac magnetic resonance (CMR) imaging were performed before surgery. The combined end-point was the occurrence of cardiac death or readmission due to heart failure. RESULTS: Linear regression analysis showed that the left ventricular ejection fraction and right ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, R2 = 0.315). Based on the receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative cardiac death with a sensitivity of 80% and a specificity of 85%. The one-year survival rate was 96% in patients with a BNP or = 200 pg/dL (p = 0.001). CONCLUSION: An elevation in the BNP level is determined by the functional status of the right and left ventricles in patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective surgery. Therefore, the BNP level should be included in the clinical evaluation and risk stratification of patients with isolated TR.

The Efficacy and Safety of Inflatable Obstetric Belts for Management of the Second Stage of Labor

This study was designed to assess the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. One hundred twenty-three nulliparas with a singleton cephalic pregnancy at term were randomized. Standard care was performed in the control group, and uterine fundal pressure by the Labor Assister(TM) (Baidy M-420/Curexo, Inc., Seoul, Korea) was utilized in addition to standard care in the active group. The Labor Assister(TM) is an inflatable obstetric belts that synchronized to apply uniform fundal pressure during a uterine contraction. The 62 women in the active group spent less time in the second stage of labor when compared to the 61 women in the control group (41.55+/-30.39 min vs. 62.11+/-35.99 min). There was no significant difference in perinatal outcomes between the two groups. In conclusion, the uterine fundal pressure exerted by the Labor Assistertrade mark reduces the duration of the second stage of labor without attendant complications.

Angiopoietin-1 Protects Endothelial Cells From Hypoxia-Induced Apoptosis via Inhibition of Phosphatase and Tensin Homologue Deleted From Chromosome Ten

BACKGROUND AND OBJECTIVES: Angiopoietin-1 (Ang1) is a regulator of blood vessel growth and maturation, and prevents radiation-induced or serum deprivation-induced apoptosis. Phosphatase and tensin homologue deleted from chromosome ten (PTEN), a well-known tumor suppressor, regulates cell cycle arrest and apoptosis. Hypoxia induces apoptosis by increasing the expression of PTEN. We hypothesized that Ang1 may regulate PTEN expression and, thus, reduce endothelial apoptosis under hypoxia in vitro and in vivo. Materials and METHODS: In vitro, human umbilical vein endothelial cells (HUVECs) were treated with Ang1, and signaling pathways were investigated. In vivo, eight-week-old C57BL/6 mice were used for a hind limb ischemia model. Ang1 or normal saline was intramusculary injected. Blood flow was evaluated by a laser Doppler perfusion analyzer and tissue histology. RESULTS: The expression of PTEN was markedly upregulated in HUVECs after hypoxic stimulation, whereas Ang1 suppressed PTEN expression. Tie2-Fc, a soluble form of Tie2 (sTie2) that blocks Ang1, reversed the Ang1 effect on PTEN reduction under hypoxia. Ang1 inhibited the nuclear translocation of nuclear transcription factor-kB (NF-kB), a binding factor for the PTEN promoter and Foxo1. Hypoxia-induced p27 expression and apoptosis were also suppressed by Ang1. In the mouse hind limb ischemia model, we observed a high capillary density, numerous proliferating cells and diminished cell death in skeletal muscle tissue in the Ang1 injected group. CONCLUSION: Ang1 enhanced endothelial cell survival by reducing apoptosis via PTEN down-regulation in HUVECs under hypoxia. Local injection of Ang1 significantly reduced apoptotic cells in vivo, and prevented limb loss for ischemic hind limb mice. Thus, Ang1 may be an effective therapeutic for protection from ischemic-endothelial cell injury.