Background: Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. Methods: From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y 12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3–5. Results: A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85–2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39–2.78).The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group,P <0.01, 95% CI 2.51–3.91). The frequency of major bleeding was not associated with the HPR in either group. Conclusion LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry.Trial Registration: ClinicalTrials.gov Identifier: NCT04734028

Purpose: Data on the distribution and impact of panel reactive antibodies (PRA) and donor specific antibodies (DSA) before lung transplantation in Asia, especially multi-center-based data, are limited. This study evaluated the prevalence of and effects of PRA and DSA levels before lung transplantations on outcomes in Korean patients using nationwide multicenter registry data. Materials and Methods: This study included 103 patients who received a lung transplant at five tertiary hospitals in South Korea between March 2015 and December 2017. Mortality, primary graft dysfunction (PGD), and bronchiolitis obliterans syndrome (BOS) were evaluated. Results: Sixteen patients had class I and/or class II PRAs exceeding 50%. Ten patients (9.7%) had DSAs with a mean fluorescence intensity (MFI) higher than 1000, six of whom had antibodies with a high MFI (≥2000). DSAs with high MFIs were more frequently observed in patients with high-grade PGD (≥2) than in those with no or low-grade (≤1) PGD. In the 47 patients who survived for longer than 9 months and were evaluated for BOS after the transplant, BOS was not related to DSA or PRA levels. One-year mortality was more strongly related to PRA class I exceeding 50% than that under 50% (0% vs. 16.7%, p=0.007). Conclusion Preoperative DSAs and PRAs are related to worse outcomes after lung transplantation. DSAs and PRAs should be considered when selecting lung transplant recipients, and recipients who have preoperative DSAs with high MFI values and high PRA levels should be monitored closely after lung transplantation.

OBJECTIVE: Previous studies reported the delayed recovery group after circadian rhythm disruption in mice showed higher quinpiroleinduced locomotor activity. This study aimed to compare not only Protein Kinase C (PKC) activities in frontal, striatal, hippocampus and cerebellum, but also relative PKC activity ratios among brain regions according to recovery of circadian rhythm. METHODS: The circadian rhythm disruption protocol was applied to eight-week-old twenty male Institute Cancer Research mice. The circadian rhythm recovery patterns were collected through motor activities measured by Mlog system. Depressive and manic proneness were examined by forced swim test and quinpirole-induced open field test respectively. Enzyme-linked immunosorbent assay was employed to measure PKC activities. RESULTS: The delayed recovery group presented greater locomotor activities than the early recovery group (p=0.033). The delayed recovery group had significantly lower frontal PKC activity than the other (p=0.041). The former showed lower frontal/cerebellar PKC activity ratio (p=0.047) but higher striatal/frontal (p=0.038) and hippocampal/frontal (p=0.007) PKC activities ratios than the latter. CONCLUSION: These findings support potential mechanism of delayed recovery after circadian disruption in bipolar animal model could be an alteration of relative PKC activities among mood regulation related brain regions. It is required to investigate the PKC downstream signaling related to the delayed recovery pattern.
Animals ; Bipolar Disorder* ; Brain ; Cerebellum ; Circadian Rhythm ; Enzyme-Linked Immunosorbent Assay ; Hippocampus ; Humans ; Male ; Mice* ; Models, Animal ; Motor Activity ; Protein Kinase C* ; Protein Kinases* ; Quinpirole

OBJECTIVE: Subdural effusion, also known as subdural hygroma (SDG), is a secondary complication that can occur after decompressive craniectomy (DC). However, the pathogenesis of SDG is not fully understood. It is unclear whether SDG occurrence is related to preoperative patient status or surgical technique. The purpose of this study is to identify risk factors for SDG after DC. METHODS: Fifty-nine patients who underwent DC from January 2016 to December 2016 at the same institution were analyzed. We retrospectively reviewed the clinical and radiological features of the patients. We divided the patients into two groups based on the occurrence of SDG after DC. The risk factors for SDG were analyzed. RESULTS: The overall SDG rate after DC was 39% (23 patients). A statistically significant association was observed between preoperative diagnosis, e.g., subdural hemorrhage (SDH; odds ratio [OR], 4.99; 95% confidence interval [CI], 1.36–18.34) or subarachnoid hemorrhage (SAH; OR, 4.18; 95% CI, 1.07–16.32), and the occurrence of SDG after DC. Traumatic brain injury (OR, 4.91; 95% CI, 1.35–17.91) and preoperative cortical opening (OR, 4.77; 95% CI, 1.39–16.32) were important risk factors for SDG. Several surgical techniques did not show a statistically significant association with SDG. The occurrence of SDG after DC was related to the length of hospital stay (p=0.012), but not to prognosis. CONCLUSION: After DC, SDG is not related to patients' prognosis but to the length of hospital stay. Therefore, it is necessary to study the occurrence of postoperative SDG by confirming the presence of preoperative SDH, SAH, and cortical opening.
Brain Injuries ; Decompressive Craniectomy* ; Diagnosis ; Hematoma, Subdural ; Humans ; Length of Stay ; Odds Ratio ; Prognosis ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage ; Subdural Effusion*

Sporotrichosis is a chronic cutaneous fungal infection caused by Sporothrix (S.) schenckii complex. Fixed cutaneous sporotrichosis is one of the three subtype of sprotrichosis and accounts for 20% of total sporotrichosis cases. However, the incidence of total sporotrichosis cases is decreasing recently due to improvement of personal hygiene and industrialization. A 60-year-old woman presented to the hospital with multiple erythematous papules and ulcers on left cheek for 5 months. Histopathologic examination revealed chronic granulomatous inflammation and immunohistochemical staining was positive for GMS and PAS stain. The fungal culture on Sabouraud dextrose agar showed grayish dark brown colonies and the sequences of ribosomal DNA internal transcribed spacer region of clinical sample was 100% similarity with S. globosa. The patient was treated with oral itraconazole 200 mg daily and topical ketoconazole cream for 3 months. At that time after this treatment, skin lesion was almost cured and recurrence is not observed to date.
Agar ; Cheek ; DNA, Ribosomal ; Female ; Glucose ; Humans ; Hygiene ; Incidence ; Inflammation ; Itraconazole ; Ketoconazole ; Middle Aged ; Recurrence ; Skin ; Sporothrix* ; Sporotrichosis* ; Ulcer

Chromoblastomycosis is a chronic subcutaneous mycotic infections caused by dermatiaceous fungi. Clinically, chromoblastomycosis presents frequently with erythematous or nodular plaque. In Korea, 10 cases of chromoblastomycosis have been reported and Fonsecaea pedrosoi is the most common agent. A 61-year-old woman who was diagnosed as chronic inflammatory demyelinating polyneuropathy 3 years ago, and had been treated with systemic corticosteroids and azathioprine, presented with pruritic, scaly erythematous plaques on the right forearm for 3 years. She had no history of trauma. Histological examination showed pseudoepitheliomatous hyperplasia, mixed granulomatous inflammatory cell infiltrate and multinucleated giant cells with sclerotic cells in the dermis. Tissue culture showed slowly growing, dark brown, velvety colony. DNA was extracted from the cultured colonies and the DNA sequence of the internal transcribed spacer (ITS) region of the clinical sample was matched for that of Fonsecaea monophora. The patient was treated with local heat therapy and topical terbinafine application.
Adrenal Cortex Hormones ; Azathioprine ; Base Sequence ; Chromoblastomycosis* ; Dermis ; DNA ; Female ; Forearm ; Fungi ; Giant Cells ; Hot Temperature ; Humans ; Hyperplasia ; Korea ; Middle Aged ; Polyneuropathies

Knowledge of clinical demographics and outcomes of mechanically ventilated patients is important but there are few prospectively collected data in Korea. The objective of the present study was to describe the current status of mechanically ventilated patients in Korea as of 2010. We analyzed the data of Korean patients (275 patients in 12 Korean intensive care units [ICU]) participating in a multinational prospective cohort study on mechanical ventilation. The most common indication for mechanical ventilation was pneumonia (23%). Pressure-limited ventilation modes were preferred over volume-cycled ventilation modes. Non-invasive positive pressure ventilation was used in only seven (2%) patients as the initial ventilatory support. Median duration of mechanical ventilation was 7 days and ICU mortality was 36%. The multiple logistic regression model revealed that the Simplified Acute Physiology Score II (SAPS II) score at ICU admission (odds ratio [OR], 1.034; 95% confidence interval [CI], 1.001-1.036; P=0.033), peak pressure (OR, 1.054; 95% CI, 1.016-1.095; P=0.006), and the number of failed organs (OR, 2.132; 95% CI, 1.634-2.781; P<0.001) were independently associated with ICU mortality. This study provides a snapshot of current practice of mechanical ventilation in Korea.
Acute Disease ; Aged ; Cohort Studies ; Demography ; Female ; Hospital Mortality ; Humans ; Intensive Care Units/*statistics & numerical data ; Length of Stay ; Male ; Middle Aged ; Odds Ratio ; Prognosis ; Prospective Studies ; Republic of Korea ; *Respiration, Artificial ; Respiratory Insufficiency/*diagnosis/epidemiology/mortality ; Sepsis/etiology ; Severity of Illness Index

BACKGROUND: We wanted to evaluate whether a minimal extrathyroid extension (METE) is associated with the clinicopathological parameters that are indicative of a poor prognosis, including lymph node metastasis, distant metastasis at the time of the initial diagnosis and tumor recurrence, in patients with papillary thyroid carcinoma (PTC), and especially in the patients with papillary thyroid microcarcinoma (PTMC). METHODS: We retrospectively evaluated the medical records of patients with PTC and who had undergone total thyroidectomy with/without subsequent 131I remnant ablation at the Korea Cancer Center Hospital from January 1998 through December 2005. A total of 557 patients with PTC were enrolled in the study. We excluded 13 patients with an unknown status of extension and 29 patients with massive ETE. RESULTS: Of the 515 patients, 401 were found to have a METE. We analyzed the 464 patients who were without distant metastasis at the time of the initial diagnosis and who had a follow-up duration of more than 6 months. METE was not significantly associated with tumor recurrence during the follow-up period (median follow-up period: 122 months, range: 6-142 months): 8% vs. 15% of the patients with and without METE had tumor recurrence, respectively (P = 0.069 by the log-rank test). We analyzed the effect of tumor size in the patients with METE. Size was not significantly associated with tumor recurrence (P = 0.374 by the log-rank test). CONCLUSION: These findings suggest that METE might not be a prognostic factor to predict tumor recurrence in patients with PTC, including PTMC.
Carcinoma ; Carcinoma, Papillary ; Factor IX ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: We assessed the absorbed dose to the tumor (Dosetumor) by using pretreatment FDG-PET and whole-body (WB) planar images in repeated radioimmunotherapy (RIT) with 131I rituximab for NHL. MATERIALS AND METHODS: Patients with NHL (n=4) were administered a therapeutic dose of (131)I rituximab. Serial WB planar images after RIT were acquired and overlaid to the coronal maximum intensity projection (MIP) PET image before RIT. On registered MIP PET and WB planar images, 2D-ROIs were drawn on the region of tumor (n=7) and left medial thigh as background, and Dosetumor was calculated. The correlation between Dosetumor and the CT-based tumor volume change after RIT was analyzed. The differences of Dosetumor and the tumor volume change according to the number of RIT were also assessed. RESULTS: The values of absorbed dose were 397.7+/-646.2cGy (53.0~2853.0cGy). The values of CT-based tumor volume were 11.3+/-9.1 cc (2.9~34.2cc), and the % changes of tumor volume before and after RIT were -29.8+/-44.3% (-100.0%~+42.5%), respectively. Dosetumor and the tumor volume change did not show the linear relationship (p>0.05). Dosetumor and the tumor volume change did not correlate with the number of repeated administration (p>0.05). CONCLUSION: We could determine the position and contour of viable tumor by MIP PET image. And, registration of PET and gamma camera images was possible to estimate the quantitative values of absorbed dose to tumor.
Antibodies, Monoclonal, Murine-Derived ; Gamma Cameras ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Radioimmunotherapy ; Thigh ; Tumor Burden ; Rituximab

BACKGROUND: Aims A neuroendocrine neoplasm (NEN) of the pancreas is rare, and can be divided into functioning and nonfunctioning NEN. This study was carried out to determine the characteristics and surgical outcomes of NEN of the pancreas experienced in a single institution. METHODS: The medical records of patients diagnosed with NEN of the pancreas (pancreatic islet-cell neoplasm) between June 1900 and June 2005 were retrospectively reviewed. RESULTS: A total of 33 patients with NEN of the pancreas were examined. Nineteen patients (57.6%) had a nonfunctioning NEN and 14 (42.4%) had a functioning NEN. By comparison, the tumor size (p=0.001), distant metastasis (p=0.042), malignant characteristics (p=0.010) and survival (p=0.002), were significantly different. Surgical resections were almost always possible in the cases of functioning NEN. Patients with functioning NENs of the pancreas had a significantly higher survival than those patients with nonfunctioning NENs (p=0.002). A curative resection provided a better survival outcome in patients with nonfunctioning NENs (p=0.005) and offered a more than 80% disease-free survival in those with functioning NENs of the pancreas. CONCLUSION: Nonfunctioning NENs of the pancreas appeared to be more aggressive than functioning NENs. A complete resection of the NENs of the pancreas can provide a good prognosis.
Disease-Free Survival ; Humans ; Medical Records ; Neoplasm Metastasis ; Pancreas* ; Prognosis ; Retrospective Studies