Myocardial infarction is the leading cause of congestive heart failure and deaths in developed countries. Current therapy is limited to the prevention of the progression of ventricular remodeling. The transplantation of stem cells into the injured myocardium is a novel and promising approach for the restoration of myocardial function. Various animal studies have suggested the potential of stem cell transplantation to regenerate myocardium and to improve cardiac function. Recently early phase I clinical studies show that stem cell therapy may have beneficial effects on ventricular remodeling. In this article, the state of the art in both laboratory and clinic on myocardial regeneration with various types of stem cells is introduced. Finally the current and intrinsic limitations of stem cell therapy are discussed along with future directions for research on stem cell therapy for ischemic heart diseases.
Animals ; Developed Countries ; Heart Failure ; Myocardial Infarction ; Myocardial Ischemia* ; Myocardium ; Regeneration ; Stem Cell Transplantation ; Stem Cells* ; Ventricular Remodeling

In the era of drug-eluting stents (DESs), the angiographic rates of restenosis at later months have been dramatically reduced, but these rates have been less prominently reduced in diabetic patients. The rate of coronary restenosis is still higher in diabetic patients, when compared with non-diabetic patients, and even after DES implantation. Diabetes remains a significant predictor of coronary restenosis even in the era of DES, and especially in cases having a small baseline vessel size, a small post-PCI vessel size and a longer stent length. The use of the sirolimus-eluting stent in diabetic patients has been associated with a decreased rate of restenosis, and this suggests a reduced risk of target lesion revascularization. Diabetes still remains a major risk factor for coronary restenosis after DES implantation, and so aggressive risk factor management with the concomitant pharmacotherapy should be done to reduce the risk of coronary restenosis.
Coronary Restenosis* ; Drug Therapy ; Drug-Eluting Stents* ; Humans ; Risk Factors ; Stents

Adult stem cells, when exposed to new environments, are remarkably plastic in their developmental potential. Bone marrow stem cells provide a promising therapy in the restoration of myocardial infarction and prevent post infarct congestive heart failure, as there is evidence that cells, such as mesenchymal stem, hematopoietic stem and multipotent adult progenitor, can generate new cardiomyocytes in animals and humans. This review summarizes stem cell therapy for cardiac regeneration after myocardial infarction, including a brief overview of ongoing clinical trials, and outlines the scientific and clinical hurdles that need to be overcome before this therapy can be fully used clinically.
Adult ; Adult Stem Cells ; Animals ; Bone Marrow ; Cardiovascular Diseases* ; Heart Failure ; Humans ; Myocardial Infarction ; Myocytes, Cardiac ; Plastics ; Regeneration ; Stem Cells*

OBJECTIVES: To examine the factors affecting passive exposure to secondhand smoke (SHS) in non-smoking student nurses. METHODS: A cross-sectional study was performed in 196 college students who had not smoked cigarettes in the past 12 months. Urinary cotinine levels were examined to identify exposure to SHS, and social factors were identified that influenced exposure to SHS, including requests that smokers extinguish cigarettes. Logistic regression analysis was used to predict the factors influencing SHS. RESULTS: Urinary cotinine measurements showed that 32 students (16.3%) were exposed to SHS. Risk factors that increased exposure to SHS affected 80 students (40.8%) in the previous 7 days. Students who were exposed to SHS were 4.45-times more likely to have increased urinary cotinine levels than those who were not exposed. Students who asked others to extinguish their cigarettes were 0.34 times less likely to test positive than those who did not. CONCLUSION: Urinary cotinine was a useful biomarker for identifying exposure to SHS, with respect to the influence of demographic, health-related, and smoking-related factors. In non-smoking nursing students, avoiding exposure to SHS was attributed to self-assertive behavior by requesting smokers to extinguish cigarettes.
Assertiveness ; Cotinine ; Cross-Sectional Studies ; Humans ; Inhalation ; Logistic Models ; Risk Factors ; Smoke ; Students, Nursing ; Tobacco Products ; Tobacco Smoke Pollution

No abstract available.
Myocardial Infarction

PURPOSE: After discharge from the hospital, very low birth weight infants require care consultation, information, and interaction and so forth, due to sequelae, different growth and developmental pattern; which increase the burdens and the worries of patients in nurturing them. With the counseling of experts in the related fields, the authors and the Food for the Hungry have run a department of childcare for a year, emphasizing on more family support than extreme early detection of disabilities. This study reports on relieving child care anxiety, promoting growth and development, educating parents on home treatment of sequelae, finding and coping with minor disabilities. METHODS: The subjects were chosen among infants under 1,500 g of birth weight and younger than a corrected age of 6 months. Meetings were held once in a month for a year. Infant care support classes were taught by experts in their fields including a music therapist (with play program), neonatologist, a children's nurse, a child-care director, a clinical psychologist, a rehabilitation therapist, a social worker and, a nutritionist. Within the self-dependent groups, the families were able to share their concerns and experiences on child-caring. Second home visits were carried out to monitor home oxygen therapy, tube feeding, cerebral palsy signs, and to find neglect or abuse in suspected cases. RESULTS: Fifty-one infants participated; the average weight was 1,060 g, the average gestational age was 27 weeks and 2 days. Eighteen were boys and 23 girls. The average age of the mothers was 33.4, and there were 26 appropriate for gestational age, 8 small for gestational age, and, 5 large for gestational age. Twenty three were first-born, 13 were second-born, 1 was third-born, and twins were 4 pairs. Home visits were done in 33 families, and secondary visits were done in 6 families. The depression score of mothers in the attendant group decreased from 10.47+/-5.18 to 8.18+/-5.87 (P=0.080). CONCLUSION: The depression score of mothers in the attendant group decreased after infant care support classes.
Anxiety ; Birth Weight ; Cerebral Palsy ; Child ; Child Care ; Counseling ; Depression ; Enteral Nutrition ; Female ; Follow-Up Studies* ; Gestational Age ; Growth and Development ; House Calls ; Humans ; Infant Care ; Infant* ; Infant, Very Low Birth Weight* ; Mothers ; Music ; Nutritionists ; Oxygen ; Parents ; Psychology ; Rehabilitation ; Social Workers ; Twins

No abstract available.
Antibodies, Antineutrophil Cytoplasmic* ; Wegener Granulomatosis*

PURPOSE: Colorectal perforation is a rare malady, but it usually presents abdominal emergency with high morbidity and mortality. It is very difficult to diagnose stercoral, idiopathic, or steroid induced perforation because these are very rare, but they show high mortality. The aims of this study are to: 1) evaluate and compare the characteristics of stercoral, idiopathic and steroid induced perforation with other perforations; and to 2) guide the diagnostic approach and treatment of these rare colon perforations. METHODS: We retrospectively reviewed thirty five patients underwent surgery for colorectal perforation at the Department of Surgery, Daedong Hospital, from November 1996 to January 2005. Age, gender, perforation site, grade of peritonitis, methods of operation and mortality rates were compared between the various causes. Logistic regression was used to evaluate their effect on mortality. RESULTS: There were 10 cases of iatrogenic colorectal injuries (28%), 7 of steroid induced colorectal perforation (20%), 5 of stab (14%), 4 of diverticulitis (11%), 4 of stercoral (11%), 3 of idiopathic (8%), and 2 of cancer induced perforation (5%). Total mortality rate of all the cases was 28.5% (10 out of 35) but the mortality of stercoral, steroid induced and idiopathic perforation was 57% (8 out of 14). The mortality rate was higher in older age group (60 years above) (40%), stercoral (75%), steroid induced (57%) and idiopathic (33%), preoperative systemic inflammatory response (SIRS) (42%), preoperative septic shock (83%), abnormal WBC count (10,000/mm3 above or 4,000/mm3 below) (53%), left colon perforation (36%) and diffuse peritonitis (56%). The mortality rate was lower in young age group (13%), iatrogenic (10%), stab (0%), right colon perforation (10%) and localized peritonitis (5%). The peritonitis grade (Hinchey's stage) of idiopathic group, cancer and stercoral was worse (III-IV grade: 75%, 100%, 75%) than that of diverticulitis, iatrogenic and stab (III-IV grade: 25%, 30%, 40%). CONCLUSION: The stercoral, steroid induced and idiopathic colorectal perforation was rare, difficult to diagnose but it showed high mortality. The characteristics of these are an older age, presenting with a high peritonitis grade, preoperative SIRS, preoperative septic shock, and occurrence below the splenic flexure. If surgeons encounter these perforations, they should perform prompt surgical management and intensive postoperative care to reduce the mortality.
Colon ; Colon, Transverse ; Diverticulitis ; Emergencies ; Humans ; Logistic Models ; Mortality ; Peritonitis ; Postoperative Care ; Retrospective Studies ; Shock, Septic

BACKGROUND: Left ventricular thrombus is a common complication after acute myocardial infarction. Methods and RESULTS: To Study the incidence of left ventricular thrombosis (LVT) after acute myocardial infarction, we performed serial two-dimensional echocardiography (2D-Echo) in 35 consecutive patients with acute myocardial infarction prospectively ; 10 patients had inferior wall myocardial infarction, 25 patients had anterior wall myocardial infarction. 2D-Echo was obtained within 3 days of acute myocardial infarction, at 4-10 days after symptom onset, and 2-4 weeks after symptom onset serially in each case. 19 out of 35 patients received thrombolytic therapy with urokinase. Left ventricular thrombi were identified in 9(25.7%) of the 35 study patients. The location of myocardial infarction was anterior and apical in all cases with left ventricular thrombi. The shape of thrombi was mural in 6 cases and protruding in 3 cases. The incidence of left ventricular thrombi in patients who received urokinase was not significantly different from that in patients who didn't(31.9% vs 18.8%,p=0.22). Wall motion score was significantly higher in patients who developed left ventricular thrombi than in patients who had no left ventricular thrombus(8.2+/-1.9 vs 5.8+/-2.6, p<0.005). All thrombi appeared within 10 days after myocardial infarction. CONCLUSIONS: Thus left ventricular thrombi develops within 10 days following myocardial infarction with large anterior and apical location. The thrombolysis therapy has no effect in the incidence of left ventricular thrombi in this study. But because of confounding effect of thrombolysis and location of myocardial infarction and extent of myocardial infarction, further investigation is needed.
Anterior Wall Myocardial Infarction ; Echocardiography ; Humans ; Incidence* ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

Myocardial infarction leads to loss of tissue and impairment of cardiac performance. Because cardiomyocytes have a limited ability to self-renewal, and thus the transplantation of adult stem cells into infarcted region is a promising therapy to regenerate damaged cardiac tissue. Stem cells for myocardial regeneration are mesenchymal- and hematopoietic stem cells derived from bone marrow, or skeletal myoblasts in animals, and these stem cells generated cardiomyocytes and endothelial cells in the infarcted regions, and improved cardiac function. Clinical data showed that autologous mesenchymal stem cells and skeletal myoblasts increased ejection fraction and blood flow, and decreased infarct size in patients. Some researchers have used a different strategy that cytokine-mobilized bone marrow cells or angioblasts homed to the infarcted region, replicated, differentiated, and improved cardiac function. The current trend is the combined use of cytokine treatment and cell transplantation to increase the efficiency of myocardial regeneration. In addition, genetic manipulation of adult stem cells has been done to express cardioprotective recombinant proteins, or enhance angiogenesis in animal study. Thus cellular transplantation, cytokine induction and gene therapy should not be viewed as competitive but rather as complementary with the common and final goal of improving the outcome of heart failure patients. In this review, we will discuss about studies for myocardial repair in animal and in patients.
Adult Stem Cells ; Animals ; Bone Marrow ; Bone Marrow Cells ; Cardiovascular System* ; Cell Transplantation ; Endothelial Cells ; Genetic Therapy ; Heart Failure ; Hematopoietic Stem Cells ; Humans ; Mesenchymal Stromal Cells ; Myoblasts, Skeletal ; Myocardial Infarction ; Myocytes, Cardiac ; Recombinant Proteins ; Regeneration ; Stem Cell Research* ; Stem Cells* ; Transplants