Objective: This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Methods: Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Results: Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Conclusion Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Background and Objectives: Although the shortage of donor is a common problem worldwide, a significant portion of unutilized hearts are classified as marginal donor (MD) hearts. However, research on the correlation between the MD and the prognosis of heart transplantation (HTx) is lacking. This study was conducted to investigate the clinical impact of MD in HTx. Methods: Consecutive 73 HTxs during 2014 and 2021 in a tertiary hospital were analyzed.MD was defined as follows; a donor age >55 years, left ventricular ejection fraction <50%, cold ischemic time >240 minutes, or significant cardiac structural problems. Preoperative characteristics and postoperative hemodynamic data, primary graft dysfunction (PGD), and the survival rate were analyzed. Risk stratification by Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was performed to examine the outcomes according to the recipient state. Each group was sub-divided into 2 risk groups according to the IMPACT score (low <10 vs. high ≥10). Results: A total of 32 (43.8%) patients received an organ from MDs. Extracorporeal membrane oxygenation was more frequent in the non-MD group (34.4% vs. 70.7, p=0.007) There was no significant difference in PGD, 30-day mortality and long-term survival between groups. In the subgroup analysis, early outcomes did not differ between low- and high-risk groups. However, the long-term survival was better in the low-risk group (p=0.01). Conclusions The outcomes of MD group were not significantly different from non-MD group. Particularly, in low-risk recipient, the MD group showed excellent early and longterm outcomes. These results suggest the usability of selected MD hearts without increasing adverse events.

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.

OBJECTIVE: We wanted to evaluate the status of self-expandable nitinol stents implanted in the P2 and P3 segments of the popliteal artery in Korean patients. MATERIALS AND METHODS: We retrospectively analyzed 189 consecutive patients who underwent endovascular treatment for stenoocclusive lesions in the femoropopliteal artery from July 2003 to March 2009, and 18 patients who underwent stent placement in popliteal arterial P2 and P3 segments were finally enrolled. Lesion patency was evaluated by ultrasound or CT angiography, and stent fracture was assessed by plain X-rays at 1, 3, 6 and 12 months and annually thereafter. RESULTS: At the 1-month follow-up, stent fracture (Type 2) was seen in one limb (up to P3, 1 of 18, 6%) and it was identified in seven limbs at the 3-month follow-up (Type 2, Type 3, Type 4) (n = 1: up to P2; n = 6: P3). At the 6-month follow-up, one more fracture (Type 1) (up to P3) was noted. At the 1-year follow-up, there were no additional stent fractures. Just four limbs (up to P2) at the 2-year follow-up did not have stent fracture. The primary patency was 94%, 61% and 44% at 1, 3 and 6 months, respectively, and the group with stent implantation up to P3 had a higher fracture rate than that of the group that underwent stenting up to P2 (p < 0.05). CONCLUSION: We suggest that stent placement up to the popliteal arterial P3 segment and over P2 in an Asian population can worsen the stent patency owing to stent fracture. It may be necessary to develop a stent design and structure for the Asian population that can resist the bending force in the knee joint.
Aged ; Aged, 80 and over ; Alloys ; Angiography ; Arterial Occlusive Diseases/radiography/*therapy/ultrasonography ; Chi-Square Distribution ; Female ; Fluoroscopy ; Humans ; Korea ; Leg/blood supply ; Male ; Middle Aged ; Peripheral Vascular Diseases/radiography/*therapy/ultrasonography ; *Popliteal Artery ; Prosthesis Failure ; Retrospective Studies ; *Stents ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color ; Ultrasonography, Doppler, Duplex ; Vascular Patency

The relation of Nogo-B to atherosclerotic plaque progression is not well understood. Thus, the purpose of this study was to assess the expression of Nogo-B in fibroatheromas (FA) of different stages, classified using virtual histology intravascular ultrasound (VH-IVUS) analysis in 19 autopsied cases of non-sudden cardiac death. VH-IVUS imaging analysis was performed 30 mm from the ostium of each coronary artery. VH-IVUS revealed 11 early FAs (34.5+/-8.3 yr), 12 late FAs (42.6+/-16.6 yr), 8 thick-cap FAs (TkCFAs) (46.4+/-11.1 yr), and 6 thin-cap FAs (TCFAs) (51.8+/-6.8 yr). TkCFAs and TCFAs were defined as advanced FA. FA progression advanced with age (P=0.04). VH-IVUS analysis of small, early FAs showed smaller necrotic cores and relatively less calcium compared to more advanced FAs with large necrotic cores (P<0.001). Histopathology and immunohistochemical stains demonstrated that early or late FAs had smaller necrotic cores, less empty space of decalcification, and greater Nogo-B expression compared to advanced FAs (vs. early FA, P=0.013; vs. late FA, P=0.008, respectively). These findings suggest that FA progression is inversely associated with Nogo-B expression. Local reduction of Nogo-B may contribute to plaque formation and/or instability.
Adult ; Age Factors ; Coronary Artery Disease/*diagnosis/pathology/ultrasonography ; Coronary Vessels/*pathology/*ultrasonography ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Myelin Proteins/*metabolism ; Ultrasonography, Interventional

BACKGROUND: There has been an increase in the number of elderly patients considered for coronary artery bypass grafting (CABG). Recently, there were many satisfactory reports of coronary artery bypass grafting (CABG) in old age due to the development in operative technique and postoperative management. We evaluated operative and follow-up results of patients 70 years of age and older compared to 60 years old. MATERIAL AND METHOD: We retrospectively studied the cases of 74 consecutive patients 70 years or older (group A) who underwent a elective CABG from January 2000 to December 2003 and compared that of relatively young age group (group B, 60-69 years old). We compared preoperative characteristics, operation technique, postoperative results that effect outcome, also we investigated late mortality and cardiac events at follow-up periods. RESULT: Preoperative demographic and clinical characteristics of two groups were not different, except preoperative renal dysfunction(serum creatinine: > or= 1.4 mg/dl) (group A 17, 23% vs group B 14, 9%) (p=0.024). There was no difference of the mean number of distal anastomosis and the left ventricular ejection fraction in group A decreased significantly from 53.7+/-13% preoperatively to 49.9+/-12% postoperatively (p=0.02), but not changed in group B. There was no difference at operative mortality rate and postoperative major morbidity rate, but wound problem of saphenous vein harvest site was significantly higher in group A than group B (6.8% vs 0.7%, p=0.02). The mean follow up duration was 24.3+/-13 months and the cumulative survival were 95.4% at 2 year and 79.9% at 4 year in group A and 95.4% at 2 year and 90.1% at 4 year in group B (p=ns). CONCLUSION: We conclude that age is not a factor of determination when we decide about operation because coronary artery bypass grafting in elderly more than 70 years old can be performed with a low mortality rate and acceptable morbidity rate.
Age Factors ; Aged ; Coronary Artery Bypass* ; Coronary Vessels* ; Creatinine ; Follow-Up Studies ; Humans ; Middle Aged ; Mortality ; Retrospective Studies ; Saphenous Vein ; Stroke Volume ; Wounds and Injuries

A case with carcinoid tumor of the appendix was encountered incidentally during an elective abdominal surgery for borderline mucinous ovarian tumor in a 16-year old female. Carcinoid tumor of appendix is the most common neoplasm of the gastrointestinal tract in childhood and adolesence. They are usually regarded as a benign neoplasm and an uncommon source of metastasis and recurrence. We report this case with reference to the value of grosss examination of the appendix and incidental appendectomy during gynecologic abdominal operations.
Adolescent ; Appendectomy ; Appendix* ; Carcinoid Tumor* ; Female ; Gastrointestinal Tract ; Humans ; Mucins* ; Neoplasm Metastasis ; Recurrence

Switch to another newer antipsychotic is indicated when current treatment is insufficiently effective or is associated with drug related adverse events that impair quality of life. There are two main switching strategies. The first `clean method' is to discontinue the previous treatment and then to start the new one. The second, more preferable method is cross-tapering where the previous and the new antipsychotic treatment are overlapped. Abrupt switching is usually indicated when severe side effects are present, but it may produce withdrawal problems or higher risk of relapse. When overlapping the previous and new treatments in cross-tapering, the daily dose of the former is tapered down progressively (by approximately 30-50% every 3 to 7 days) and the latter is started and titrated up progressively to achieve a therapeutic response. In relation to the speed of cross-tapering, it is important to maintain adequate therapeutic level of overlapping drugs to avoid relapse or adverse events associated with subtherapeutic or too high level of overlapping drugs. Caution is advised in patients who have suffered recent relapse, a severe psychotic episode or who are being treated as outpatients. Anticholinergic medication, if needed, should be continued for 2-4 weeks after the switch has been made. Treatment should be individualized. At least three months of full-dose treatment is required for the decision of successful drug switch. Patient education and frequent monitoring is essential in switching medications. Switch from clozapine need more caution and clozapine should be tapered slowly for 2-6 weeks except in inevitable cases. In this review, the advantages of switching to a newer antipsychotic drug in the management of patients with schizophrenia have been demonstrated while successful switching strategies being presented.
Clozapine ; Humans ; Outpatients ; Patient Education as Topic ; Quality of Life ; Recurrence ; Schizophrenia

BACKGROUND AND OBJECTIVES: High C-reactive protein (CRP) levels are associated with an increased risk of cardiovascular diseases. The hydroxymethyl glutaryl Coenzyme A reductase inhibitors (statin) lowers the CRP level in the population of developed countries. The aim of the study was to evaluate the effect of statin on the CRP levels in Korean hypercholesterolemic patients without atherosclerotic diseases. SUBJCETS AND METHODS: A total of 32 patients with hypercholesterolemia, administered 20 mg lovastatin or 10 mg atorvastatin, and the same number of similar aged, sex-matched, hypercholesterolemic patients, as a control group, were enrolled. Non-drug measures were recommended for those without the medication. The patients with atherosclerotic cardiovascular diseases were excluded. The lipid profiles and high sensitive CRP levels were measured before and after 2 months of the medication. RESULTS: The baseline CRP levels were not related to the levels of lipids. Statin therapy reduced the CRP levels from 2.17+/-2.40 (median value 1.11) mg/L to 1.24+/-1.79 (0.68) mg/L (p=0.003). In all the cases, the magnitude of change in the CRP was related to the statin therapy allocation and the magnitude of changes in the total and low density lipoprotein cholesterols in a univariate analysis. Multiple stepwise regression analysis showed that only the statin therapy allocation was an independent variable. For each group, no significant relationship between the changes of CRP and lipids was observed. CONCLUSION: Short term statin therapy reduced the CRP levels in Korean hypercholesterolemic patients without atherosclerotic diseases, and the phenomenon was independent of the changes in lipids.
C-Reactive Protein* ; Cardiovascular Diseases ; Cholesterol, LDL ; Coenzyme A* ; Developed Countries ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Lovastatin ; Oxidoreductases* ; Atorvastatin Calcium