Thrombomodulin (TM) is thrombin receptor present on the luminal surface of endothelial cells. Because the thrombin-TM complex acts as an anticoagulant, the functional variants or deficiency of TM may lead to increment of thrombotic tendency. In this study, we screened the genetic variants of the TM gene in patients with myocardial infarction (MI) and analyzed the genotype to elucidate the effects of genetic variations of TM gene on the development of the MI. We screened a promoter region and coding sequence of the TM gene using single strand conformation polymorphism-heteroduplex analysis and identified three common genetic variants: those were TM G-33A, TM Ala455Val, and TM C1922T. The genotype frequencies were investigated in the patients with MI (n=234) and control subjects (n=291) by the method of allele-specific oligomer hybridization. The frequencies of mutant genotypes (TM -33A, TM 455Val, and TM 1922T) were higher in patient group compared to the control subjects in males while there were no significant differences in females. In the multiple logistic regression analysis, TM 455Val and TM 1922T alleles were independent risk factors for MI (OR[95% CI: 1.799[1.125-2.878] p=0.014 and 5.624[1.019-31.025], p=0.048, respectively) in males. However, the genetic variations were not independent risk factors for MI in females. There were significant linkage disequilibriums among three genetic variants. These linkage disequilibriums explain the similar effects of three genetic variants on the development of MI. To investigate the effect of the TM G-33A mutation on TM promoter activity, the two TM promoter constructs (pTM-355 and pTM-125, bearing TM -33G or TM -33A) containing of firefly luciferase gene were transfected into HepG2, BAE, and CHO cells. The promoter activities were higher in the promoter constructs with TM -33G compared to the constructs with TM -33A in pTM-355. These results suggest the possibility of the positive predisposing effect of TM -33A allele on MI in males. The functional study for TM Ala455Val and TM C1922T should be followed to elucidate the genotype effects of these mutations on the development of MI. In this study, we identified three genetic variants of TM gene and showed the significant associations between genetic variants and MI in males. These results proposed that TM gene is an attractive candidate for genetic risk factor for MI in Koreans.
Alleles ; Animals ; CHO Cells ; Clinical Coding ; Cricetinae ; Endothelial Cells ; Female ; Fireflies ; Genetic Variation ; Genotype ; Humans ; Linkage Disequilibrium ; Logistic Models ; Luciferases ; Male ; Myocardial Infarction* ; Phenobarbital ; Promoter Regions, Genetic ; Receptors, Thrombin ; Risk Factors* ; Thrombomodulin

No abstract available.
Catheters* ; Humans

BACKGROUND: The present study estimated healthcare costs of osteoporotic fractures including spine, hip, distal radius and humerus in Koreans over 50 years of age using national claims data. METHODS: Korea National Health Insurance data between 2008 and 2011 was searched for all claims records of outpatient visits or hospital admissions of patients ≥50-year-of-age. Osteoporosis-related fractures were identified using certain the International Classification of Diseases, Tenth Revision codes and site-specific physician claims for procedures in a patient age cut-off value of 50 years. The healthcare costs included acute phase costs accounting for emergency medical care given immediately after fracture, costs due to further hospitalization and surgical procedures, physiotherapy sessions according to the site of the fracture, and outpatient visits in the year after discharge. RESULTS: The total estimated healthcare costs of osteoporotic fractures in 2011 was $722 million. From 2008 to 2011, the total number and healthcare costs of osteoporotic fractures increased 28.9% (from 127,070 to 163,823) and 31.6% (from $549 million to $722 million), respectively. The portion of national health care expenditure was ranged from 2.3% in 2008 to 2.2% in 2011. The mean healthcare cost of osteoporotic fractures per person increased 2.1% from $4,321 in 2008 to $4,410 in 2011.The mean healthcare costs were highest for hip fractures followed by spine, humerus, and distal radius fractures. CONCLUSIONS: Total Healthcare costs of osteoporotic fractures in South Koreans ≥50-year-of-age increased between 2008 and 2011. This trend will likely continue, which is an important health problem in the elderly population and economically.
Aged ; Delivery of Health Care* ; Emergencies ; Health Care Costs* ; Health Expenditures ; Hip ; Hip Fractures ; Hospitalization ; Humans ; Humerus ; International Classification of Diseases ; Korea* ; National Health Programs* ; Osteoporotic Fractures* ; Outpatients ; Radius ; Radius Fractures ; Spine

We report a case of subcutaneous phaeohyphomycosis caused by Exophiala(E,) jeanselmei in a 66-year-old female, who showed a mild tender, 4.5x3.5cm sized, erythematous cystic mass with satellite lesions on the left forearm for 4 months. Histopathologically, suppurative granulomatous inflammation, brownish conidia in a chain and hyphae were observed. Fungal culture grew out the typical black-gray velvety colonies of E. jeanselmei after 2 weeks. The isolate grow well at 25 C, but very poorly at 37 C. No growth could be observed at 40 C. Sporulation adequate for evaluation was present on the malt extract agar. We confirmed E. jeanselmei by colony and microscopic morphology, temperature tolerance and sugar assimilation tests. The patient had been treated with itraconazole for 6 momths. Complete remission was observed.
Agar ; Aged ; Exophiala* ; Female ; Forearm ; Humans ; Hyphae ; Inflammation ; Itraconazole ; Phaeohyphomycosis* ; Spores, Fungal

No abstract available.
Peritoneal Dialysis, Continuous Ambulatory*

BACKGROUND: Antiplatelet drugs play an important role in the prevention and treatment of coronary artery diseases. Triflusal, an antiplatelet drug structually related to acetylsalicylic acid, selectively inhibits the cyclooxygenase of platelet and thromboxane A2 formation. However there is a controversy about the clinical dosage and the quantitative evaluation of the platelet antiaggregatory effect of triflusal. In this study we have evaluated the platelet antiaggregatory effect and cost-effective dosage of triflusal in the whole blood of healthy volunteers. METHODS: Using the whole blood of 50 healthy people, we performed a baseline platelet aggregation function test induced by adenosine diphosphate (ADP) and collagen. The subjects were subdivided into 3 treated groups (300 mg, 600 mg, 900 mg). We compared the platelet aggregation effect between the baseline results and 2 weeks after triflusal administration. RESULTS: Triflusal inhibited the platelet aggregation induced by ADP and collagen in the 600 mg administration group most effectively. The platelet aggregation induced by collagen was inhibited dose-dependently. The definite inhibitory responders (% inhibition > or = 25) for platelet aggregation induced by collagen were more common than those induced by ADP (33% vs 27% in 300 mg, 71% vs 53% in 600 mg, 78% vs 39% in 900 mg). There were no serious clinical side-effects except gastrointestinal trouble. One volunteer in the 900 mg treated group discontinued the treatment due to epigastric pain. CONCLUSION: We conclude that triflusal has a dose-dependent inhibitory effect on platelet aggregation induced by collagen and that the most effective dosage for platelet antiaggregation effect is 600 mg per day.
Adenosine Diphosphate ; Aspirin ; Blood Platelets* ; Collagen ; Coronary Artery Disease ; Electric Impedance* ; Evaluation Studies as Topic ; Healthy Volunteers* ; Platelet Aggregation Inhibitors ; Platelet Aggregation* ; Prostaglandin-Endoperoxide Synthases ; Thromboxane A2 ; Volunteers

BACKGROUND: Antiplatelet drugs play an important role in the prevention and treatment of coronary artery diseases. Triflusal, an antiplatelet drug structually related to acetylsalicylic acid, selectively inhibits the cyclooxygenase of platelet and thromboxane A2 formation. However there is a controversy about the clinical dosage and the quantitative evaluation of the platelet antiaggregatory effect of triflusal. In this study we have evaluated the platelet antiaggregatory effect and cost-effective dosage of triflusal in the whole blood of healthy volunteers. METHODS: Using the whole blood of 50 healthy people, we performed a baseline platelet aggregation function test induced by adenosine diphosphate (ADP) and collagen. The subjects were subdivided into 3 treated groups (300 mg, 600 mg, 900 mg). We compared the platelet aggregation effect between the baseline results and 2 weeks after triflusal administration. RESULTS: Triflusal inhibited the platelet aggregation induced by ADP and collagen in the 600 mg administration group most effectively. The platelet aggregation induced by collagen was inhibited dose-dependently. The definite inhibitory responders (% inhibition > or = 25) for platelet aggregation induced by collagen were more common than those induced by ADP (33% vs 27% in 300 mg, 71% vs 53% in 600 mg, 78% vs 39% in 900 mg). There were no serious clinical side-effects except gastrointestinal trouble. One volunteer in the 900 mg treated group discontinued the treatment due to epigastric pain. CONCLUSION: We conclude that triflusal has a dose-dependent inhibitory effect on platelet aggregation induced by collagen and that the most effective dosage for platelet antiaggregation effect is 600 mg per day.
Adenosine Diphosphate ; Aspirin ; Blood Platelets* ; Collagen ; Coronary Artery Disease ; Electric Impedance* ; Evaluation Studies as Topic ; Healthy Volunteers* ; Platelet Aggregation Inhibitors ; Platelet Aggregation* ; Prostaglandin-Endoperoxide Synthases ; Thromboxane A2 ; Volunteers

We identified a neuroprotective single fraction among 62 ones of hexane extract from Uncaria sinensis (JGH43IA) and investigated its effects and mechanisms in primary cortical neurons. Pretreatment with JGH43IA showed a significantly increase cell viability in a dose-dependent manner with a decrease in the lactate dehydrogenase release. When we performed morphological assay and flow cytometry to determination of the type of cell death, pretreatment with JGH43IA showed a significant reduction of glutamate-induced apoptotic cell death. Then we explored the downstream signaling pathways of N-methyl-D-aspartate receptor (NMDAR) with calpain activation to elucidate possible pathways of neuroprotection by JGH43IA. Pretreatment with JGH43IA exhibited a significant attenuation of NMDAR GluN2B subunit activation and a decrease in active form of calpain 1 leading to subsequent cleavage of striatal-enriched protein tyrosine phosphatase (STEP). In addition, pretreatment with JGH43IA showed a marked increase of cAMP responsive element binding protein. These results suggest that JGH43IA may have neuroprotective effects through down-regulation of NMDAR GluN2B subunit and calpain 1 activation, and subsequent alleviation of STEP cleavage. This single fraction from U. sinensis might be a useful therapeutic agent for brain disorder associated with glutamate injury.
Brain Diseases ; Calpain ; Carrier Proteins ; Cell Death ; Cell Survival ; Down-Regulation ; Flow Cytometry ; Glutamates ; Glutamic Acid ; L-Lactate Dehydrogenase ; N-Methylaspartate ; Neurons* ; Neuroprotective Agents* ; Protein Tyrosine Phosphatases ; Receptors, N-Methyl-D-Aspartate ; Uncaria*

BACKGROUND AND OBJECTIVES: Candesartan cilexetil (Atacand ), a selective type I angiotensin II receptor blocker, has recently been introduced as a new antihypertensive agent. We evaluated its anti-hypertensive effect and safety in mild to moderate hypertensive patients. MATERIALS AND METHODS: Candesartan cilexetil, 8 mg or 16 mg, was administered once a day over 8 weeks period in the patients with mild to moderate hypertension (25 male, 26 female, mean age: 53.5+/-1.2 years). For safety evaluation, laboratory tests were performed before and after treatment with candesartan cilexetil. Changes in blood pressure, heart rate and electrocardiogram were also observed. RESULTS: 1) The mean blood pressures in the sitting position were systolic 164.1+/-2.1 mmHg and diastolic 106.3+/-0.8 mmHg before treatment, which were lowered to 135.4+/-2.0 mmHg and 89.1+/-1.1 mmHg, repectively after 8 weeks of treatment (p<0.05). 2) Candesartan cilexetil had a significant dose-dependent antihypertensive effect for diastolic pressure in 35 patients (8 mg: 97.8+/-0.9 mmHg, 16 mg: 91.3+/-1.1 mmHg, p<0.05). 3) Heart rate was not significantly changed before and after treatment during the treatment with candesartan cilexetil (72.2+/-1.2/min vs. 72.0+/-1.3/min: p>0.05). 4) Laboratory tests revealed no significant abnormality by the treatment with candesartan cilexetil. 5) Left ventricular hypertrophy by ECG criteria detected in 3 cases disappeared after treatment with candesartan cilexetil. 6) No significant side effects were observed during the treatment period. CONCLUSION: Candesartan cilexetil, 8 mg or 16 mg, once a day is an effective and well tolerated antihypertensive treatment. It has a significant dose-dependent antihypertensive effect.
Blood Pressure ; Electrocardiography ; Female ; Heart Rate ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Male ; Receptors, Angiotensin

BACKGROUND: Myocardial contrast echocardiography(MCE) has been known to be a safe and useful method to assess the adequacy of myocardial perfusion. This study was performed to assess the change of myocardial perfusion following successful percutaneous transluminal coronary angioplasty using MCE in the patients with significant coronary arterial obstructive diseases. METHODS: The study comprised of eight patients(mean age 55 years, male 7, female 1). Four patients were unstable angina and four patients post non-Q wave myocardial infarction angina. Six patients had one vessel disease and two paients two vessel disease. All patients underwent successful PTCA at the proximal(2 patients) and the mid(6 patients) left anterior descending coronary artery. Pre- and post-PTCA myocardial perfusion was assessed by comparing peak contrast intensity and slope of time-intensity curve after injection of hand-agitated Hexabrix(6cc) respectively. The variables were measured off-line at thirty two end-diastolic frames of the left ventricle in each patient. RESULTS: 1) Diameter stenosis of target lesion changed from 91±9 to 24±14% after successful coronary angioplasty(p < 0.005). 2) Peak contrast intensity was increased from 47.4±30.7 to 64.9±36.4 gray scale U/pixel in anteroseptal segment and from 46.6±14.3 to 67.9±35.8 gray scale U/pixel in anterior segment(p < 0.05). 3) The slope of time-intensity curve after PTCA became more steeper compared to that of pre-PTCA(anteroseptal : −0.32±0.48 vs −0.76±0.66 p=0.071, anterior : −0.33±0.39 vs −0.81±0.80 p=0.086). 4) During the study, there was no significant clinical or hemodynamic complications except three patients who developed transisient sinus bradycardia after intracoronary injection of handagitated Hexabrix. CONCLUSION: Myocardial contrast echocardiography appeared to be safe and useful in the evaluation of myocardial perfusion following coronary angioplasty assessed by the changes of peak contrast intensity and slope of contrast time-intensity curve.
Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary ; Arterial Occlusive Diseases ; Bradycardia ; Constriction, Pathologic ; Coronary Vessels ; Echocardiography ; Female ; Heart Ventricles ; Hemodynamics ; Humans ; Ioxaglic Acid ; Male ; Methods ; Myocardial Infarction ; Perfusion