Breast Tissue Reconstruction Using Polycaprolactone Ball Scaffolds in a Partial Mastectomy Pig Model.

BACKGROUND: Breast cancer patients suffer from lowered quality of life (QoL) after surgery. Breast conservancy surgery (BCS) such as partial mastectomy is being practiced and studied as an alternative to solve this problem. This study confirmed breast tissue reconstruction in a pig model by fabricating a 3-dimensional (3D) printed Polycaprolactone spherical scaffold (PCL ball) to fit the tissue resected after partial mastectomy. METHODS: A 3D printed Polycaprolactone spherical scaffold with a structure that can help adipose tissue regeneration was produced using computer-aided design (CAD). A physical property test was conducted for optimization. In order to enhance biocompatibility, collagen coating was applied and a comparative study was conducted for 3 months in a partial mastectomy pig model. RESULTS: In order to identify adipose tissue and fibroglandular tissue, which mainly constitute breast tissue, the degree of adipose tissue and collagen regeneration was confirmed in a pig model after 3 months. As a result, it was confirmed that a lot of adipose tissue was regenerated in the PCL ball, whereas more collagen was regenerated in the collagen-coated Polycaprolactone spherical scaffold (PCL-COL ball). In addition, as a result of confirming the expression levels of TNF-a and IL-6, it was confirmed that PCL ball showed higher levels than PCL-COL ball. CONCLUSION: Through this study, we were able to confirm the regeneration of adipose tissue through a 3-dimensional structure in a pig model. Studies were conducted on medium and large-sized animal models for the final purpose of clinical use and reconstruction of human breast tissue, and the possibility was confirmed.

Associations between Body Mass Index, Waist Circumference, and Myocardial Infarction in Older Adults Aged over 75 Years: A Population-Based Cohort Study.

Background and Objectives: Body mass index (BMI) is widely used as a standard screening method for obesity and an indicator of related diseases. However, its inability to distinguish between lean body mass and body fat limits its utility. This limitation may be more prominent in older populations, wherein age-related sarcopenia and increased visceral fat due to the redistribution of adipose tissue may preclude a precise estimation of obesity. Many studies suggest that waist circumference (WC) is more strongly related to obesity-related diseases. There are also different opinions on whether the obesity paradox is real or a result of confusing interpretations. This study seeks to determine the association between myocardial infarction (MI), BMI, and WC in older adults and to determine if BMI and WC can reliably predict the risk of cardiovascular disease. Materials and Methods: We conducted a cohort study of older Korean adults aged over 75 years registered in the National Health Insurance System Senior database. Results: The results from the analysis using model 5, which was adjusted for each study variable, showed that the lower the BMI, the higher the hazard ratio (HR) of MI and vice versa. On the other hand, groups with lower than normal WC showed lower HR; even if it was higher, the difference was not statistically significant. Those with abdominal obesity tended to have an increased HR of MI. Conclusions: This study found that HR for MI has a negative relationship with BMI, whereas it has a positive relationship with WC. Furthermore, WC is a more appropriate indicator for predicting the risk of MI in the older population.

Appropriate Amount of Regular Exercise Is Associated with a Reduced Mortality Risk.

PURPOSE: This study aimed at investigating whether there is a continuous dose-response relationship between the amount of physical activity (PA) and longevity benefit. METHODS: We evaluated the records of 23,257,723 Koreans age ≥20 yr who had undergone one biennial medical evaluation by the National Health Insurance Corporation. Participants with ≥20 min of vigorous or ≥30 min of moderate PA or walking were stratified into four groups: 0 d·wk; 1-3 d·wk; 4 to 5 d·wk; and 6-7 d·wk. After calculating total metabolic equivalent task-hours per week (MET·h·wk), we created eight categories of MET-hours per week (0, 0.1-4.9, 5.0-9.9, 10.0-14.9, 15.0-19.9, 20.0-24.9, 25.0-29.9, and ≥30.0). Multivariate Cox proportional hazard analyses were performed. RESULTS: A reverse J-shaped risk curve was observed, with the lowest mortality risk in the participants exercising 4 to 5 d·wk (reference). Participants who did not exercise at all and those who exercised with a PA frequency of 1 to 3 d·wk or 6 to 7 d·wk showed a significantly increased mortality risk compared with the reference group. When we repeated the Cox analysis among the 8 MET·h·wk categories with the participants reporting 20.0 to 24.9 MET·h·wk of PA as the reference group, we found that those with physical inactivity and 25.0-29.9 or ≥30.0 MET·h·wk of PA showed a higher mortality risk than the reference group. These relationships were persistently observed after adjustment for confounders. CONCLUSIONS: An appropriate amount of regular exercise in each specific type of PA was associated with the lowest risk of mortality. The inactive participants showed an increased mortality risk, and daily PA did not show any additional benefit in the mortality risk.

Suicidal ideation among postmenopausal women on hormone replacement therapy: The Korean National Health and Nutrition Examination Survey (KNHANES V) from 2010 to 2012.

BACKGROUND: Suicide is a major public health problem around the world. Some studies have found that hormone replacement therapy (HRT) is associated with depression in postmenopausal women. Depression is a well-known risk factor for suicide; therefore, we investigated the relationship between HRT and suicidal ideation in postmenopausal Korean women. METHODS: We included 2286 postmenopausal women with or without HRT from the Korean National Health and Nutrition Examination Survey 2010-2012. The use and duration of HRT and mental health status, including stress, depressive mood, and suicidal ideation and attempts, were assessed by self-report questionnaires. RESULTS: The proportion of participants with depressive mood and suicidal ideation was higher in the HRT group than the non-HRT group (all p values<0.05). As the duration of HRT increased, the percentage of participants with suicidal ideation increased (p for trend=0.006). After adjusting for all covariates, the odds ratio (95% confidence intervals) for suicidal ideation was 1.742 (1.223-2.482) in the women with HRT, compared to women without HRT. HRT duration longer than 10 years was associated with suicidal ideation (odds ratio=2.089 and 95% confidence intervals=1.069-4.084). LIMITATIONS: The cross-sectional design, a possibility of incorrect answer about menopausal status, and no assessment of the type of HRT are the main limitations of this study. CONCLUSION: Postmenopausal women receiving HRT, especially for more than 10 years, showed increased suicidal ideation compared with postmenopausal women without HRT. Physicians should pay attention to mood symptoms and suicidal ideation in postmenopausal women with HRT.

Structure-activity relationships of amide-phosphonate derivatives as inhibitors of the human soluble epoxide hydrolase.

Structure-activity relationships of amide-phosphonate derivatives as inhibitors of the human soluble epoxide hydrolase (sEH) were investigated. First, a series of alkyl or aryl groups were substituted on the carbon alpha to the phosphonate function in amide compounds to see whether substituted phosphonates can act as a secondary pharmacophore. A tert-butyl group (16) on the alpha carbon was found to yield most potent inhibition on the target enzyme. A 4-50-fold drop in inhibition was induced by other substituents such as aryls, substituted aryls, cycloalkyls, and alkyls. Then, the modification of the O-substituents on the phosphonate function revealed that diethyl groups (16 and 23) were preferable for inhibition to other longer alkyls or substituted alkyls. In amide compounds with the optimized diethylphosphonate moiety and an alkyl substitution such as adamantane (16), tetrahydronaphthalene (31), or adamantanemethane (36), highly potent inhibitions were gained. In addition, the resulting potent amide-phosphonate compounds had reasonable water solubility, suggesting that substituted phosphonates in amide inhibitors are effective for both inhibition potency on the human sEH and water solubility as a secondary pharmacophore.

Normal range albuminuria and metabolic syndrome in South Korea: the 2011-2012 Korean National Health and Nutrition Examination Survey.

BACKGROUND: It is well-known that there is a close relationship between metabolic syndrome (MetS) and microalbuminuria. However, some recent studies have found that even normal range albuminuria was associated with MetS and cardiometabolic risk factors. The purpose of this study is to analyze the relationship between MetS and normal range albuminuria and to calculate the cutoff value for albuminuria that correlates with MetS in the representative fraction of Korean population. METHODS: Data were obtained from the 2011-2012 Korea National Health and Nutrition Examination Survey and included 9,650 subjects aged ≥ 19 years. We measured metabolic parameters: fasting blood glucose, waist circumference, blood pressure, and lipids, and albumin-to-creatinine ratio (ACR). The optimal ACR cutoff points for MetS were examined by the receiver operating characteristic curve. Multivariate logistic regression was used to obtain the prevalence of MetS and its components according to the ACR levels. RESULTS: The first cutoff value of ACR were 4.8 mg/g for subjects with ≥ 3 components of MetS. There was a graded association between ACR and prevalence of MetS and its components. If ACR was <4 mg/g, there was no significant increase in the prevalence of MetS or its components. From the ACR level of 4-5 mg/g, the prevalence of MetS significantly increased after adjusting for age, sex, body mass index, smoking, alcohol intake, exercise, and medications for diabetes mellitus and hypertension (odds ratio; 95% confidence intervals = 1.416; 1.041-1.926). CONCLUSIONS: Albuminuria within the normal range (around 5 mg/g) was associated with prevalence of MetS in the Korean population.

Impaired RV global longitudinal strain is associated with poor long-term clinical outcomes in patients with acute inferior STEMI.

OBJECTIVES: The aim of this study was to assess the long-term prognostic value of the global longitudinal strain of the right ventricle (GLSRV) in patients with inferior ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). BACKGROUND: RV systolic dysfunction is an important prognostic factor in patients with inferior STEMI. METHODS: All consecutive inferior STEMI patients were included from January 2005 to December 2013. RV systolic function was analyzed with GLSRV using velocity vector imaging (Siemens, Mountain View, California), as well as conventional echocardiographic indices, including right ventricular fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE). RESULTS: We analyzed a total of 282 consecutive inferior STEMI patients (212 men, age 63 ± 13 years) treated with primary PCI. During the follow-up period (54 ± 35 months), 59 patients (21%) had 1 or more major adverse cardiovascular event (MACE) (43 deaths, 7 nonfatal MI, 4 target vessel revascularization, and 6 heart failure admission). The best cutoff value of GLSRV for the prediction of MACE was ≥-15.5% (area under the curve = 0.742, p < 0.001) with a sensitivity of 73% and a specificity of 65%. GLSRV showed better sensitivity and specificity than RVFAC and TAPSE. After multivariate analysis, GLSRV showed a higher c-statistic value (0.770) than RVFAC (0.749) and TAPSE (0.751) in addition to age, Killip class, troponin-I, left ventricular (LV) ejection fraction and RV infarction. Patients with GLSRV≥-15.5% showed significantly lower 5-year survival rate (74 ± 5% vs. 89 ± 3%, p < 0.001) and lower MACE-free survival rate (64 ± 5% vs. 87 ± 3%, p < 0.001) than the control group. CONCLUSIONS: Because GLSRV showed additive predictive value to age and LV function, it can be the strongest parameter of RV systolic function evaluating the prognosis after PCI for acute inferior STEMI particularly in patients with preserved LV function.

Endovascular treatment in a patient with left main coronary and pulmonary arterial stenoses as an initial manifestation of Takayasu's arteritis.

Takayasu's arteritis is a chronic inflammatory disorder that mainly involves medium to large sized arteries. Although it affects coronary and pulmonary arteries occasionally, physicians should consider the possibility of involvement of coronary or pulmonary arteries in patients with Takayasu's arteritis with chest pain or exertional dyspnoea. We report a case of Takayasu's arteritis who presented with exertional dyspnoea and generalised oedema due to severe bilateral pulmonary and left main coronary arterial stenoses. The patient was successfully treated by a one-stage percutaneous transluminal balloon angioplasty and stent implantation of the involved left main coronary and pulmonary arteries. The endovascular treatment may be one of the treatment options for the stenotic vascular lesions in patients with Takayasu's arteritis.

Lateral growth of ZnO nanorod arrays in polyhedral structures for high on-current field-effect transistors.

Lateral growth of one-dimensional nanostructures is crucial for high performance field-effect transistors (FETs) which can drive a high on-current that is proportional to the number of nanorods (NRs) aligned between electrodes. Hence, it is strongly required to laterally and directly grow a large number of NRs between electrodes. For the first time, we propose a polyhedral-type FET (PH-FET) based on laterally-grown ZnO NRs, which includes circle, square and triangle configurations. The PH-FET structure not only provides a larger contact area than that of the planar parallel-type FET so that a great number of ZnO NRs are aligned between electrodes, but also generates a high on-current in the mA range (i.e., 5.5-6.8 mA). The high on-current PH-FET opens up a new range of applications for power devices where large currents have to be switched.

Prevalence and clinical implications of newly revealed, asymptomatic abnormal ankle-brachial index in patients with significant coronary artery disease.

OBJECTIVES: This study sought to evaluate the association between newly revealed abnormal ankle-brachial index (ABI) and clinical outcomes in patients with significant coronary artery stenosis. BACKGROUND: Little is known about the prevalence and clinical implications of ABI in patients with no claudication or previous history of peripheral artery disease who undergo diagnostic coronary angiography. METHODS: Between January 1, 2006, and December 31, 2009, ABI was evaluated in 2,543 consecutive patients with no clinical history of claudication or peripheral artery disease who underwent diagnostic coronary angiography. Abnormal ABI was defined as ≤0.9 or ≥1.4. The primary endpoint was the composite of death, myocardial infarction, and stroke over 3 years. RESULTS: Of the 2,543 patients, 390 (15.3%) had abnormal ABI. Of the 2,424 patients with at least 1 significant stenosis (≥50%) in a major epicardial coronary artery, 385 (15.9%) had abnormal ABI, including 348 (14.4%) with ABI ≤0.9 and 37 (1.5%) with ABI ≥1.4. During a median follow-up of 986 days, the 3-year major adverse event rate was significantly higher in patients with abnormal than normal ABI (15.7% vs. 3.3%, p < 0.001). After multivariate analysis, abnormal ABI was identified as a predictor of primary endpoint (hazard ratio [HR]: 1.87; 95% confidence interval [CI]: 1.23 to 2.84; p = 0.004). After adjustment by propensity-score matching, abnormal ABI could predict adverse clinical events in patients with established coronary artery disease (HR: 2.40; 95% CI: 1.41 to 4.10; p = 0.001). CONCLUSIONS: The prevalence of newly revealed abnormal, asymptomatic ABI among patients who have significant CAD on coronary angiography was 15.9%. The presence of abnormal ABI was associated with a higher incidence of adverse clinical outcomes over 3 years.

Comparison of dual versus triple antiplatelet therapy after drug-eluting stent according to stent length (from the pooled analysis of DECLARE trials).

There are no practical criteria for the use of triple antiplatelet therapy after drug-eluting stent (DES) implantation. In our present report, pooled analysis of 3 randomized studies in patients with diabetes mellitus (Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte Restenosis in patients with diabetes mellitus trial) and long coronary narrowings (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions trials I and II) compared triple (aspirin, clopidogrel, and cilostazol; triple group, n = 700) and dual antiplatelet therapies (aspirin and clopidogrel; dual group, n = 699) after DES implantation. Among pooled population (n = 1,399 patients), 1,173 patients with follow-up angiography were divided into 3 stent length categories (≤20, 20 to 40, and >40 mm). There was no statistical significance of in-stent restenosis (ISR) in ≤20- and 20- to 40-mm categories between 2 groups. However, ISR rate was significantly reduced in triple versus dual group in >40-mm stent length category (12.4% vs 22.1%, p = 0.008). In diabetic patients, triple group also showed significant reduction in the ISR rate in >40-mm stent length category (15.4% vs 32.3%, p = 0.003). According to postprocedural minimal lumen diameter, triple group showed a trend toward a lower ISR than that of the dual group in all categories (p = 0.033 for ≤2.5 mm, p = 0.087 for 2.5 to 3.0 mm, and p = 0.119 for >3.0 mm). In conclusion, the triple group had a significantly reduced ISR in patients with >40-mm stent length after DES implantation compared with the dual group. Therefore, this suggestion for use of triple antiplatelet therapy could be easily applied after DES implantation in routine clinical practice.

Models for estimating the biological age of five organs using clinical biomarkers that are commonly measured in clinical practice settings.

OBJECTIVES: To date, no worldwide studies have been conducted to estimate the biological age of five organs using clinical biomarkers that are associated with the aging status. Therefore, we conducted this study to develop the models for estimating the biological age of five organs (heart, lung, liver, pancreas, and kidney) using clinical biomarkers which are commonly measured in clinical practice. DESIGN: A cross sectional study. METHODS: Subjects were recruited from the routine health check-up centers in Korea from 2004 through 2010. Data obtained from 121,189 subjects (66,168 men and 55,021 women) were used for clinical evaluation and statistical analysis. We examined the relations between clinical biomarkers associated with five organs and the chronological age and proposed a model for estimating the biological age of five organs. RESULTS: In the models for predicting the biological ages of the heart, lung, liver, pancreas and kidney in men, 12, 2, 8, 3, and 5 parameters were respectively included (R(2)=0.652, 0.427, 0.107, 0.245, and 0.651). In contrast to men, 10, 2, 8, 3, and 5 parameters in women were respectively included (R(2)=0.780, 0.435, 0.140, 0.384, and 0.501). CONCLUSION: We first proposed the models for predicting the biological age of five organs in the current study. We developed those using clinical parameters that can be easily obtained in clinical practice settings. Our biological age prediction models may be used as supplementary tools to assess the aging status of five organs in clinical practice settings.

Differential prognostic effect of intravascular ultrasound use according to implanted stent length.

It is unknown whether the use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention can attenuate the stent length effect on clinical outcomes. The aim of the present study was to determine the differential prognostic effect of IVUS according to the implanted stent length. We enrolled 3,244 consecutive patients from the Interventional Cardiology Research In-cooperation Society-Drug-Eluting Stents (IRIS-DES) registry who had undergone single or overlapping stent implantation. The primary end point was major adverse cardiac events (MACE; a composite of death, myocardial infarction, and target vessel revascularization). The study population was divided by the tertiles of implanted stent length and IVUS usage. IVUS use was at the discretion of the operator. After adjusting for significant covariates, the stent length was significantly associated with the risk of MACE in the no-IVUS group (hazard ratio 1.13, 95% confidence interval 1.01 to 1.28, p = 0.042) but not in the IVUS group (hazard ratio 1.08, 95% confidence interval 0.97 to 1.20, p = 0.16). In addition, in patients with an implanted stent length of ≤22 mm (n = 998), the risk of MACE was not significantly different between the IVUS group and the no-IVUS group (hazard ratio 1.06, 95% confidence interval 0.50 to 2.28, p = 0.88). In contrast, in patients with a longer implanted stent length, the risk of MACE was significantly lower in the IVUS group than in the no-IVUS group (hazard ratio 0.47, 95% confidence interval 0.24 to 0.92, p = 0.027 for 23 to 32 mm, n = 1,109; hazard ratio 0.57, 95% confidence interval 0.33 to 0.98, p = 0.042 for ≥33 mm, n = 1,137). In conclusion, IVUS usage can attenuate the detrimental effect of the increase in the implanted stent length, supporting IVUS usage, particularly during percutaneous coronary intervention with long stent implantation.

Transient use of oral bosentan can be an additional option to reduce pulmonary arterial hypertension in a patient with severe pulmonary arterial hypertension associated with atrial septal defect.

Atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) is thought to preclude shunt closure. However, there are several reports that vasodilator treatment is associated with good clinical outcome in these patients, recently. We report a case of good clinical outcome in a patient with ASD and severe PAH successfully treated with operative closure of ASD and subsequent use of oral bosentan medication. This case supports that the corrective repair of ASD and an oral bosentan treatment can be one of the treatment options in the selected patients with severe PAH associated with ASD.

Lysyl oxidase G473A polymorphism is closely associated with susceptibility to gastric cancer in a South Korean population.

The aim of this study was to determine whether a single nucleotide polymorphism at G473A (rs1800449) within the LOX-propeptide is associated with susceptibility to gastric cancer. We investigated the genotype and allele frequencies of this gene in tissue specimens from 458 gastric cancer patients and 282 healthy individuals. Polymorphism analysis was performed by amplifying the propeptide region of LOX and digestion with NotI followed by sequencing of the products. The frequencies of the LOX G473A G/G, G/A, and A/A genotypes were 54.4% (249/458), 34.3% (157/458), and 11.3% (52/458), respectively, in gastric cancer patients and 58.9% (166/300), 35.5% (100/282), and 5.7% (16/282), respectively, in the healthy controls. Statistically significant differences in the genotype and allele frequency of LOX rs1800449 were observed between the healthy controls and gastric cancer patients (p = 0.0294 and p = 0.0339). When the data were stratified according to gastric cancer histologic subtype, the risk of diffuse-type gastric cancer in carriers with an A allele (G/A or A/A genotypes) was statistically higher compared to that of carriers with the G/G genotype (p = 0.0001). Our findings suggest that G473A polymorphism of the LOX gene may be closely associated with susceptibility to the development and differentiation of gastric cancer in South Korean patients.

Endothelial dysfunction in the smokers can be improved with oral cilostazol treatment.

BACKGROUND: Smoking is one of well known environmental factors causing endothelial dysfunction and plays important role in the atherosclerosis. We investigated the effect of cilostazol could improve the endothelial dysfunction in smokers with the measurement of flow-mediated dilatation (FMD). METHODS: We enrolled 10 normal healthy male persons and 20 male smokers without any known cardiovascular diseases. After measurement of baseline FMD, the participants were medicated with oral cilostazol 100 mg bid for two weeks. We checked the follow up FMD after two weeks and compared these values between two groups. RESULTS: There was no statistical difference of baseline characteristics including age, body mass index, serum cholesterol profiles, serum glucose and high sensitive C-reactive protein between two groups. However, the control group showed significantly higher baseline endothelium-dependent dilatation (EDD) after reactive hyperemia (12.0 ± 4.5% in the control group vs. 8.0 ± 2.1% in the smoker group, p = 0.001). However, endothelium-independent dilatation (EID) after sublingual administration of nitroglycerin was similar between the two groups (13.6 ± 4.5% in the control group vs. 11.9 ± 4.9% in the smoker group, p = 0.681). Two of the smoker group were dropped out due to severe headache. After two weeks of cilostazol therapy, follow-up EDD were significantly increased in two groups (12.0 ± 4.5% to 16.1 ± 3.7%, p = 0.034 in the control group and 8.0 ± 2.1% to 12.2 ± 5.1%, p = 0.003 in the smoker group, respectively). However, follow up EID value was not significantly increased compared with baseline value in both groups (13.6 ± 4.5% to 16.1 ± 3.7%, p = 0.182 in the control group and 11.9 ± 4.9% to 13.7 ± 4.3%, p = 0.430 in the smoker group, respectively). CONCLUSION: Oral cilostazol treatment significantly increased the vasodilatory response to reactive hyperemia in two groups. It can be used to improve endothelial function in the patients with endothelial dysfunction caused by cigarette smoking.

Iatrogenic left internal mammary artery to great cardiac vein anastomosis treated with coil embolization.

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.

High performance field-effect transistors fabricated with laterally grown ZnO nanorods in solution.

We have exploited a method for the lateral growth of multiple ZnO nanorods between electrodes in solution without the use of a metal catalyst to fabricate high performance field-effect transistors (FETs). This method enables us to directly align overlapped or overlap-free nanowires between electrodes by eliminating the vertical growth components and complex structural networks. The overlap-free ZnO nanorod FETs showed better performance with a mobility of ∼ 8.5 cm(2) V( - 1) s( - 1) and an on/off ratio of ∼ 4 × 10(5) than the overlapped ZnO nanorod FETs having a mobility of ∼ 5.3 cm(2) V( - 1) s( - 1) and an on/off ratio of ∼ 3 × 10(4). All the FETs fabricated in this work showed much better performance than the previously reported solution-based ZnO FETs.

Structure-activity relationships of cycloalkylamide derivatives as inhibitors of the soluble epoxide hydrolase.

Structure-activity relationships of cycloalkylamide compounds as inhibitors of human sEH were investigated. When the left side of amide function was modified by a variety of cycloalkanes, at least a C6 like cyclohexane was necessary to yield reasonable inhibition potency on the target enzyme. In compounds with a smaller cycloalkane or with a polar group on the left side of amide function, no inhibition was observed. On the other hand, increased hydrophobicity dramatically improved inhibition potency. Especially, a tetrahydronaphthalene (20) effectively increased the potency. When a series of alkyl or aryl derivatives of cycloalkylamide were investigated to continuously optimize the right side of the amide pharmacophore, a benzyl moiety functionalized with a polar group produced highly potent inhibition. A nonsubstituted benzyl, alkyl, aryl, or biaryl structure present on the right side of the cycloalkylamide function induced a big decrease in inhibition potency. Also, the resulting potent cycloalkylamide (32) showed reasonable physical properties.

A Case of Acute ST-Segment Elevation Myocardial Infarction Mimicking Stress Induced Cardiomyopathy; Demonstration of Typical Echocardiographic Finding Correlated with Unusual Distribution of Left Anterior Descending Coronary Artery.

Stress-induced cardiomyopathy (SCMP) is diagnosed in 1-2% of patients presenting with symptoms suggestive of acute coronary syndrome. Because of sharing many common clinical features with SCMP, acute ST-segment elevation myocardial infarction (STEMI) can be misdiagnosed as SCMP. However, it can be associated with fatal outcome of the patient. Also, diagnosis of SCMP seems to be always challenging to clinicians, especially in the decision of taking coronary angiography which is still invasive and even risky. Here, we present a case with acute STEMI mimicking SCMP as a result of anatomical variation of coronary circulation. In this patient, prompt and early coronary angiography and stent implantation was very helpful.