BACKGROUND: Recently, VE1, a monoclonal antibody against the BRAFV600E mutant protein, has been investigated in terms of its detection of the BRAFV600E mutation. Although VE1 immunostaining and molecular methods used to assess papillary thyroid carcinoma in surgical specimens are in good agreement, evaluation of VE1 in thyroid cytology samples is rarely performed, and its diagnostic value in cytology has not been well established. In present study, we explored VE1 immunoexpression in cytology samples from ex vivo papillary thyroid carcinoma specimens in order to minimize limitations of low cellularity and sampling/targeting errors originated from thyroid fineneedle aspiration and compared our results with those obtained using the corresponding papillary thyroid carcinoma tissues. METHODS: The VE1 antibody was evaluated in 21 cases of thyroid cytology obtained directly from ex vivo thyroid specimens. VE1 immunostaining was performed using liquid-based cytology, and the results were compared with those obtained using the corresponding tissues. RESULTS: Of 21 cases, 19 classic papillary thyroid carcinomas had BRAFV600E mutations, whereas two follicular variants expressed wild-type BRAF. VE1 immunoexpression varied according to specimen type. In detection of the BRAFV600E mutation, VE1 immunostaining of the surgical specimen exhibited 100% sensitivity and 100% specificity, whereas VE1 immunostaining of the cytology specimen exhibited only 94.7% sensitivity and 0% specificity. CONCLUSIONS: Our data suggest that VE1 immunostaining of a cytology specimen is less specific than that of a surgical specimen for detection of the BRAFV600E mutation, and that VE1 immunostaining of a cytology specimen should be further evaluated and optimized for clinical use.
Biopsy, Fine-Needle ; Immunohistochemistry ; Mutant Proteins ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND/AIMS: There have been reports that interatrial septal (IAS) thickness is increased in patients with atrial fibrillation (AF). This study was performed to investigate whether IAS thickness determined by transthoracic echocardiography (TTE) represents the amount of left atrium (LA) structural and functional remodeling. METHODS: The study population consisted of 104 consecutive patients who underwent catheter ablation (CA) for AF (paroxysmal atrial fibrillation [PAF], 82; persistent atrial fibrillation [PeAF], 22). IAS thickness and left atrium volume (LAV) using TTE, and LA voltage (LAVOL) using 3-dimensional electroanatomical mapping system were assessed during sinus rhythm. RESULTS: IAS thickness was significantly correlated with maximal LAV (LAVmax) (r = 0.288, p = 0.003), mean LAVOL (r = -0.537, p < 0.001), total left atrium emptying fraction (LAEFtotal; r = -0.213, p = 0.030), and active LAEF (LAEFactive; r = -0.249, p = 0.014). IAS thickness was greater in the high-risk group (> or = 2) compared to other groups according to CHA2DS2-VASc score (p = 0.019). During a follow-up of 19.6 months, 23 subjects (22.1%; PAF, 17; PeAF, 6) had recurrence of arrhythmia. Univariate analysis showed that LAVmax, minimal LAV, mean LAVOL, LVEFtotal, LVEFactive, and IAS thickness were associated with recurrence of arrhythmia. However, on multivariate analysis, only mean LAVOL and LAEFactive were independent risk factors for recurrence. CONCLUSIONS: Although IAS thickness showed significant correlations with parameters for LA structural and functional remodeling, this parameter alone could not independently predict recurrence of arrhythmia after CA for AF.
Action Potentials ; Adult ; Aged ; Area Under Curve ; Atrial Fibrillation/physiopathology/*radiography/surgery/*ultrasonography ; *Atrial Function, Left ; *Atrial Remodeling ; Atrial Septum/physiopathology/*radiography/*ultrasonography ; Catheter Ablation ; Chi-Square Distribution ; *Echocardiography, Doppler ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; *Multidetector Computed Tomography ; Multivariate Analysis ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Recurrence ; Risk Factors ; Time Factors ; Treatment Outcome

PURPOSE: The purpose of the study was to compare obstetric and perinatal outcomes according to glucose challenge test (GCT) in a single institution. METHODS: One thousand six women, who were underwent antepartum gestational diabetes mellitus (GDM) screening by a GCT in mid-pregnancy and delivered at National Health Service between January 1, 2007 and July 31, 2012, were included in the study. The medical records of patients were analyzed retrospectively. The Subjects were categorized into three groups according to the results of 50 g oral GTC and 100 g oral GTC; normal glucose tolerance (NGT, n=826), less than 140 mg/dL; gestational impaired glucose tolerance (GIGT, n=128), more than 140 mg/dL but non-GDM ; gestational diabetes mellitus (GDM, n=52). Pre-existed maternal DM or hypertension and twin pregnancy were excluded. Obstetric and perinatal outcomes were compared among the three groups. RESULTS: Maternal age, parity, and pre-pregnancy body mass index were higher in the GDM. The preterm delivery and gestational hypertension increased across the groups from NGT to GIGT to GDM (13.9% vs. 18.8% vs. 25.0%, P<0.01, and 1.9% vs.5.5% vs. 13.5%, P<0.01, respectively). Large for gestational age (LGA) and Neonatal Intensive Care Unit admission rate were higher in order in NGT, GIGT, and GDM (6.2% vs. 15.6% vs. 15.4%, P<0.01, and 12.3% vs. 24.2% vs. 38.5%, P<0.01), but other complications requiring intensive care were not different among the groups, including meconium aspiration syndrome and birth asphyxia. CONCLUSION: GDM was a risk factor of cesarean section, preterm delivery, and gestational hypertension. In addition, GIGT was positively correlated with gestational hypertension, preterm labor, cesarean section rate, and LGA. This study suggests that there is a need to develop a guideline for Korean pregnant women who were diagnosed with GIGT.
Asphyxia ; Body Mass Index ; Cesarean Section ; Diabetes, Gestational ; Female ; Gestational Age ; Glucose* ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Infant, Newborn ; Critical Care ; Intensive Care, Neonatal ; Mass Screening ; Maternal Age ; Meconium Aspiration Syndrome ; Medical Records ; National Health Programs ; Obstetric Labor, Premature ; Parity ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Twin ; Pregnant Women* ; Retrospective Studies ; Risk Factors

A 0.035-inch guide wire fracture and entrapment in a peripheral artery is a very rare complication, but when it does occur it may lead to life-threatening complications, such as perforation, thrombus formation, embolization, and subsequent limb ischemia. We describe our experience of successfully retrieving a fractured 0.035-inch Terumo guide wire in the external iliac artery using a biopsy forcep.
Angioplasty, Balloon, Coronary ; Arteries ; Biopsy ; Extremities ; Femoral Artery ; Iliac Artery ; Ischemia ; Surgical Instruments ; Thrombosis

BACKGROUND AND OBJECTIVES: Although the use of heterogeneous overlapping drug-eluting stents (DES) is not uncommon in clinical practice, whether the implantation sequences of heterogeneous DES will influence the endothelialization or arterial responses differently remains unclear. MATERIALS AND METHODS: Twenty-one rabbits were randomized to receive overlapping stents in the iliac artery for 3 months {distal sirolimus-eluting stent (SES, Cypher(TM))+proximal paclitaxel-eluting stent (PES, Taxus(TM)) (C+T, n=7), distal Taxus+proximal Cypher (T+C, n=7) and bare metal stent (BMS)+BMS (B+B, n=7)}. Endothelial function was evaluated by the acetylcholine provocation test during follow-up angiography. Histopathological changes in proximal, overlapped, and distal stented segments were evaluated. RESULTS: Although the overall angiographic outcomes were comparable, late loss (mm) in the distal stented segment was higher in the B+B (0.39+/-0.07) and C+T (0.40+/-0.20) than that in the T+C (0.06+/-0.02) group (p<0.001). The incidence of acetylcholine-induced spasm was higher in the DES groups compared with BMS, regardless of the implantation sequences (85.7% in C+T vs. 14.3% in B+B vs. 71.4% in T+C, p=0.017). Notably, only the distal Cypher implantation group (C+T) had three cases of stent fracture. A histopathological analysis showed that despite similar arterial injury scores, Taxus and Cypher stents had higher inflammatory reactions at the overlapped and distal segments compared with those of BMS. CONCLUSION: Despite similar arterial injury, higher inflammatory reactions were observed in overlapping DES segments regardless of the implantation sequence compared with that of BMS. Moreover, DES was associated with impaired endothelial function on the adjacent non-stented segments.
Acetylcholine ; Angiography ; Drug-Eluting Stents ; Endothelium ; Follow-Up Studies ; Iliac Artery ; Incidence ; Rabbits ; Spasm ; Stents ; Taxus ; Vasoconstriction

BACKGROUND AND OBJECTIVES: Since statins and angiotensin receptor blockers are a frequently prescribed combination in patients with atherosclerotic cardiovascular diseases, we tested the interactive effects of simvastatin and losartan on atherosclerosis in apolipoprotein E (apoE)-/- mice. MATERIALS AND METHODS: Apolipoprotein E-/- mice were fed a high-fat, high-cholesterol (HFHC) diet for 12 weeks, with and without simvastatin (40 mg/kg) and/or losartan (20 mg/kg). The mice were divided into 5 groups and were fed as follows: regular chow (control diet, n=5), HFHC diet (n=6), HFHC diet with losartan (n=6), HFHC diet with simvastatin (n=6), and HFHC diet with both losartan and simvastatin (n=6). RESULTS: Losartan treatment in apoE-/- mice significantly decreased atherosclerotic lesion areas in whole aortic strips stained with Oil Red O. The plaque area measured at the aortic sinus level was reduced significantly by 17% (HFHC; 346830.9+/-52915.8 microm2 vs. HFHC plus losartan; 255965.3+/-74057.7 microm2, p<0.05) in the losartan-treated group. Simvastatin and simvastatin plus losartan treatments reduced macrophage infiltration into lesions by 33% (HFHC; 183575.6+/-43211.2 microm2 vs. HFHC plus simvastatin; 120556.0+/-39282.8 microm2, p<0.05) and 44% (HFHC; 183575.6+/-43211.2 microm2 vs. HFHC plus simvastatin and losartan; 103229.0+/-8473.3 microm2, p<0.001, respectively). In mice fed the HFHC diet alone, the smooth muscle cell layer in the aortic media was almost undetectable. In mice co-treated with losartan and simvastatin, the smooth muscle layer was more than 60% preserved (p<0.05). Given alone, losartan showed a slightly stronger effect than simvastatin; however, treatment with losartan plus simvastatin induced a greater inhibitory effect on atherosclerosis than either drug given alone. Serum lipid profiles did not differ significantly among the groups. CONCLUSION: Losartan displayed anti-atherosclerotic effects in apoE-/- mice that were equivalent to or greater than the effects of simvastatin. Combined treatment with these drugs had greater effect than either drug alone.
Angiotensin Receptor Antagonists ; Animals ; Apolipoproteins ; Atherosclerosis ; Azo Compounds ; Cardiovascular Diseases ; Diet ; Humans ; Losartan ; Macrophages ; Mice ; Mice, Knockout ; Models, Animal ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Simvastatin ; Sinus of Valsalva

This study aimed to develop a Korean version of the Type D Personality Scale-14 (DS14) and evaluate the psychiatric symptomatology of Korean cardiac patients with Type D personality. Healthy control (n = 954), patients with a coronary heart disease (n = 111) and patients with hypertension and no heart disease (n = 292) were recruited. All three groups completed DS14, the Eysenck Personality Questionnaire (EPQ), the state subscale of Spielberger State and Trait Anxiety Inventory (STAI-S), the Center for Epidemiologic Studies Short Depression Scale (CESD), and the General Health Questionnaire (GHQ). The Korean DS14 was internally consistent and stable over time. 27% of the subjects were classified as Type D. Type D individuals had significantly higher mean scores on the STAI-S, CESD, and GHQ compared to non-Type D subjects in each group. The Korean DS14 was a valid and reliable tool for identifying Type D personality. The general population and cardiovascular patients with Type D personality showed higher rate of depression, anxiety and psychological distress regarding their health. Therefore, identifying Type D personality is important in clinical research and practice in chronic medical disorders, especially cardiovascular disease, in Korea.
Anxiety Disorders/diagnosis ; Asian Continental Ancestry Group/ethnology/*psychology ; Coronary Disease/diagnosis ; Humans ; Hypertension/diagnosis ; Personality/*classification ; *Personality Assessment/statistics & numerical data ; Psychometrics ; Questionnaires ; Republic of Korea ; Risk Factors

BACKGROUND AND OBJECTIVES: Angiotensin-receptor blockers (ARBs) have beneficial effects on cardiovascular, metabolic, and inflammatory parameters in addition to controlling blood pressure (BP). However, few comparative clinical studies have been conducted with different ARBs. We compared these effects in patients with uncomplicated hypertension who were receiving telmisartan or valsartan. SUBJECTS AND METHODS: The subjects were patients with essential hypertension (48.4+/-9.6 years) who were randomly assigned to take either telmisartan (80 mg/day, n=30) or valsartan (160 mg/day, n=30) for 12 weeks. Their anthropometric, laboratory, vascular, and echocardiographic data were measured at baseline and at the end of the study. RESULTS: Baseline characteristics were not significantly different between the two groups, except for the carotid-femoral pulse wave velocity (cfPWV; telmisartan group vs. valsartan group; 841.2+/-131.0 vs. 761.1+/-104.4 cm/s, p<0.05). After 12 weeks, BP had fallen to a similar extent with mean reductions in the systolic and diastolic BP of 20.7+/-18.1 and 16.3+/-13.0 mm Hg (p<0.001, respectively) for the telmisartan and 22.5+/-17.0 and 16.8+/-9.3 mm Hg (p<0.001, respectively) for the valsartan group. Although the cfPWV and left ventricular mass index (LVMI) fell significantly only with the administration of telmisartan, they were not significantly different when baseline cfPWV was considered. The differences in the cfPWV and LVMI changes from baseline between the two groups were also not significant after adjusting for baseline cfPWV. No significant changes in other vascular, metabolic, or inflammatory parameters were observed with either treatment. CONCLUSION: The effects of a 12-week treatment with the two ARBs, telmisartan and valsartan, on cardiovascular, metabolic, and inflammatory parameters were not different in patients with uncomplicated hypertension.
Benzimidazoles ; Benzoates ; Blood Pressure ; Humans ; Hypertension ; Pulse Wave Analysis ; Tetrazoles ; Valine ; Valsartan

PURPOSE: Plasma levels of renin, angiotensin II and aldosterone are increased during normal pregnancy. However, these values in preeclampsia are decreased to nearly that of a nonpregnant subject, and vascular sensitivity to angiotensin II is increased. In preeclampsia, aldosterone is decreased less than rennin. Therefore current studies were undertaken to determine the relationship between aldosterone to renin ratio (ARR) and uterine artery perfusion via RI value. MATERIALS AND METHODS: In this study, the relationship between plasma aldosterone and renin concentration was determined in 27 preeclamptic women and 50 normal pregnant women, whose gestational weeks were matched. The aldosterone to renin ratio was calculated and compared between the two groups. Doppler velocimetry of the uterine artery, which was used to calculate resistance index (RI), was performed on all subjects. The relationship between ARR and RI value was reviewed. RESULTS: In the preeclampsia group, RI value of the uterine artery was significantly higher than that of normal pregnant women. Both plasma renin and aldosterone concentrations were lower in the preeclampsia group. However, the ratio of these two parameters was significantly higher (38.3 vs. 16.1, p < 0.001); the greater ARR, the higher the RI of the uterine artery (r(2)=0.053, p=0.048). CONCLUSION: This study demonstrates that a high aldosterone to renin ratio may have a negative effect on perfusion of the uterine artery and play an important role in the pathophysiology of preeclampsia.
Adult ; Aldosterone/*blood ; Arteries/metabolism ; Case-Control Studies ; Female ; Gestational Age ; Health ; Humans ; Pre-Eclampsia/*blood ; Pregnancy ; Renin/*blood ; Uterus/*blood supply/*metabolism

The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p=0.006), sepsis (85.7% vs. 44%, p =0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p=0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p=0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p=0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p=0.0192), RDS (30% vs. 8%, p=0.0085), IVH (26% vs. 4%, p=0.0070), sepsis (44% vs. 14%, p=0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p=0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.
Premature Birth/*mortality ; Pregnancy Outcome/*epidemiology ; Pregnancy ; Pre-Eclampsia/mortality ; Male ; Infant, Newborn ; Humans ; HELLP Syndrome/*mortality ; Female ; Adult