PURPOSE: To investigate the effect of lateral buttress on the fracture healing of Jensen type 4 intertrochanteric fracture of the femur treated by dynamic compression hip screw (DCS) in elderly patients, retrospectively. MATERIALS AND METHODS: From March 1999 to February 2003, 54 patients, older than 65 years, of Jensen type 4 intertrochanteric fractures of the femur treated by DCS were included. The relationship between the structual integrity of lateral buttress measured by proximal-medial fragment angle (PMFA) and postoperative neck-shaft angle, penetrating length of lag screw, the sliding length and incidence of fixation loss were evaluated. RESULTS: Among 38 patients of group II (PMFA above 50 degree), 6 cases (15.8%) including 4 cases of cutting out of lag screw from femoral head, 1 case of nonunion and 1 case of excessive extrusion of lag screw failed radiologically. But there was no fixation loss case in 16 cases of group I (PMFA 50 and below 50). The neck-shaft angle in last follow-up was 138.1 degree in group I and 132.1 in group II. The sliding length of lag screw was 7.0 mm in group I and 12. 5 mm in group II (p<0.05). CONCLUSION: Preoperative evaluation of intactness of lateral buttress measured by proximal-medial fragmentary angle is an useful method in treatment of Jensen type 4 intertrochanteric fractures treated by DCS in elderly patients.
Aged* ; Femur* ; Follow-Up Studies ; Fracture Healing ; Head ; Hip Fractures* ; Hip* ; Humans ; Incidence ; Retrospective Studies

PDGF-BB has been recognized as a highly potential growth factor for guided tissue regeneration in periodontal defect. This study carried out histologic and histometric evaluation of 200ng/cm2 PDGF-BB loaded bioresorbable membrane made from polyglycolic and polylactic acid. It was tested for its biocompatibility, ability to prevent epithelial downgrowth and amount of periodontal regeneration. Without membrane and PDGF-BB unloaded bioresorbable membrane were used as control. Healthy six beagle dogs were used. Each dog was anesthetized and buccal flaps were reflected in the mandibular and maxillary premolar areas. Buccal alveolar bone between the mesiobuccal and distobuccal line angles was surgically removed on the lower 2nd and 4th premolar in mandible, 2nd premolar in maxilla, to a level 4mm apical to the cementoenamel junction with creating a Class II buccal furcation defect for available space. Care was taken not to remove the root cementum layer and rubber impression materials were placed over each surgically created defect. Flaps were repositioned and sutured. Reconstructive surgery was performed 1 month after defect preparation. PDGF-BB loaded membranes and controls were randomly placed on maxillary 2nd premolars and mandibular 2nd and 4th premolars. Plaque control regimen was instituted with daily brushing with a 0.1% chlorhexidine digluconate during experimental periods. The animals were sacrificed 2 and 5 weeks after surgery and undecalcified specimens were prepared for histologic evaluation. The degree of coronal regrowth of new bone, new cementum and the amonut of new bone areas formed on the defected area of the PDGF-BB loaded membrnae turned superior to without membrane and drug unloaded membrane. Experimental membrane could prevent the epithelial downgrowth irrespective of drug loaded or not and showed good biocompatiblity. These results implicated that PDGF-BB loaded bioresorbable membrane could be highly useful tool for guided tissue regeneration of periodontal defects.
Animals ; Bicuspid ; Chlorhexidine ; Dental Cementum ; Dogs ; Furcation Defects ; Guided Tissue Regeneration ; Mandible ; Maxilla ; Membranes* ; Platelet-Derived Growth Factor* ; Regeneration* ; Rubber ; Tooth Cervix

BACKGROUND/AIMS: Bleeding from esophageal varices (EV) is a major cause of death in patients with liver cirrhosis. Endoscopic screening is recommended for diagnosing EV, but various noninvasive parameters can also be used to predict EV. The liver stiffness measurement (LSM), a noninvasive technique for estimating liver fibrosis, was recently reported to be strongly correlated with the hepatic venous pressure gradient. This study evaluated the usefulness of LSM for predicting the presence and size of EV in patients with cirrhosis. METHODS: The relationships of LSM with the presence and size of EV were analyzed in 112 patients with liver cirrhosis. Liver cirrhosis was diagnosed histologically or clinically. The presence and size of EV were assessed by endoscopy, and LSM was determined by the Fibroscan(R) technique. RESULTS: LSM was strongly correlated with the presence of EV (P<0.0001): the LSM value was 42.7+/-21.9 kPa (mean+/-standard deviation) in patients with EV (n=82) and 19.1+/-12.6 kPa in patients without EV (n=30). The area under the receiver operating characteristic curve was 0.818 (95% CI, 0.732-0.904) for predicting the presence of EV, and an LSM value of 19.7 kPa was predictive of the presence of EV with a sensitivity of 87%, a specificity of 70%, a PPV of 89%, and a NPV of 66%. However, there was a weak correlation between LSM and the size of EV. CONCLUSIONS: LSM is useful for predicting the presence of EV in patients with cirrhosis but not their size.
Adult ; Aged ; Elasticity ; Esophageal and Gastric Varices/etiology/*ultrasonography ; Female ; Hepatic Veins ; Humans ; Liver/*ultrasonography ; Liver Cirrhosis/*complications/physiopathology ; Male ; Middle Aged ; Portal Pressure ; Predictive Value of Tests ; ROC Curve ; Severity of Illness Index

No abstract available.
Peripheral Vascular Diseases*

BACKGROUND/AIMS: Colorectal cancer, one of the most common cancers in developed countries, is curable when diagnosed at an early stage. However, for better screening, both a test that patients will tolerate and diagnostic accuracy are required. We compared patient experiences and preferences between computed tomographic (CT) colonography and conventional colonoscopy (CC) under conscious sedation. METHODS: Patients referred to the gastrointestinal clinic for CC were enrolled to also undergo CT colonography prior to CC. After each procedure, patients completed a questionnaire in which variables, such as abdominal pain, abdominal discomfort, and loss of dignity, were assessed using a 7-point Likert scale, with the highest score representing the worst experience. To verify response stability, a telephone questionnaire followed within 24 h after each procedure. Patients were then asked about their preference for CT colonography or CC. RESULTS: Data were collected from 51 patients who fulfilled all requirements, including CT colonography, CC, the two questionnaires after each procedure, and a follow-up questionnaire. Severity of abdominal pain, abdominal discomfort, and a loss of dignity were reported to be higher in CT colonography than in CC (p<0.01). In addition, the preference for CC was significantly higher than that for CT colonography (p<0.01). CONCLUSIONS: Although CT colonography is a safe and noninvasive screening test for colorectal cancer, further study is required to increase patient acceptance.
Colonography, Computed Tomographic/*methods/psychology ; Colonoscopy/*methods/psychology ; Colorectal Neoplasms/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Male ; Mass Screening/*methods/psychology ; Middle Aged ; Patient Acceptance of Health Care/*psychology ; *Patient Satisfaction ; Prospective Studies ; Questionnaires

The global obesity epidemic and associated metabolic diseases require alternative biological targets for new therapeutic strategies. In this study, we show that a phytochemical sulfuretin suppressed adipocyte differentiation of preadipocytes and administration of sulfuretin to high fat diet-fed obese mice prevented obesity and increased insulin sensitivity. These effects were associated with a suppressed expression of inflammatory markers, induced expression of adiponectin, and increased levels of phosphorylated ERK and AKT. To elucidate the molecular mechanism of sulfuretin in adipocytes, we performed microarray analysis and identified activating transcription factor 3 (Atf3) as a sulfuretin-responsive gene. Sulfuretin elevated Atf3 mRNA and protein levels in white adipose tissue and adipocytes. Consistently, deficiency of Atf3 promoted lipid accumulation and the expression of adipocyte markers. Sulfuretin’s but not resveratrol’s anti-adipogenic effects were diminished in Atf3 deficient cells, indicating that Atf3 is an essential factor in the effects of sulfuretin. These results highlight the usefulness of sulfuretin as a new anti-obesity intervention for the prevention of obesity and its associated metabolic diseases.
Activating Transcription Factor 3 ; Adipocytes ; Adiponectin ; Adipose Tissue, White ; Animals ; Diet* ; Insulin Resistance ; Metabolic Diseases* ; Mice ; Mice, Obese* ; Microarray Analysis ; Obesity* ; RNA, Messenger

BACKGROUND/AIMS: Alcohol and the hepatitis B virus (HBV) exert synergistic effects in hepatocelluar carcinogenesis. We aimed to elucidate the clinical significance of the antibody to hepatitis B core antigen (anti-HBc) and occult HBV infection on the development of hepatocellular carcinoma (HCC) in patients with alcoholic liver cirrhosis (LC). METHODS: Patients with alcoholic LC alone (n=193) or combined with HCC (n=36), who did not have HBsAg or antibody to hepatitis C virus were enrolled. Clinical data and laboratory data including anti-HBc were investigated at enrollment. The polymerase chain reaction was applied to HBV DNA using sera of patients with HCC or LC after age and sex matching. RESULTS: Patients with HCC were older (60+/-11 years vs. 53+/-10 years, mean+/-SD, P<0.001), more likely to be male (100% vs. 89%, P=0.03), and had a higher positive rate of anti-HBc (91.2% vs. 77.3%, P=0.067), and a higher alcohol intake (739+/-448 kg vs. 603+/-409 kg, P=0.076) than those with LC. Age was the only significant risk factor for HCC revealed by multiple logistic regression analysis (odds ratio, 1.056; P=0.003). The positive rate of anti-HBc and alcohol intake did not differ in age- and sex-matched subjects between the LC (n=32) and HCC (n=31) groups. However, the detection rate of serum HBV DNA was higher in the HCC group (48.4%) than in the LC group (0%, P<0.001). CONCLUSIONS: Anti-HBc positivity is not a risk factor for HCC. However, occult HBV infection may be a risk factor for HCC in patients with alcoholic LC.
Adult ; Aged ; Antibodies, Viral/blood ; Carcinoma, Hepatocellular/diagnosis/epidemiology/*etiology ; DNA, Viral/analysis ; Female ; Hepatitis B/*complications/diagnosis ; Hepatitis B Core Antigens/*immunology ; Hepatitis B Surface Antigens/immunology ; Hepatitis B virus/genetics/immunology/isolation & purification ; Hepatitis C/complications/diagnosis ; Humans ; Liver Cirrhosis, Alcoholic/*complications/diagnosis/epidemiology ; Liver Neoplasms/diagnosis/epidemiology/*etiology ; Male ; Middle Aged ; Risk Factors

BACKGROUND AND OBJECTIVES: Nicorandil has pharmacologic effects similar to nitroglycerin and potassium in respect to the channel opening action in vascular smooth muscle cells. We examined hemodynamic changes in patients following nicorandil infusion. We investigated the action mechanism of nicorandil, and whether nicorandil affects hemodynamic changes in patients receiving antianginal medication. SUBJECTS AND METHODS: A total of 17 patients (11 normal control group, 6 coronary artery disease group) undergoing cardiac catheterization for investigation of chest pain participated in this study. During cardiac catheterization, nicorandil was infused into the pulmonary artery at a dose of 80 microgram/kg over a period of 1 min. Hemodynamic parameters were measured before and at 5, 10 and 20 minutes after nicorandil infusion. RESULTS: Five minutes after nicorandil infusion, the maximal changes in preload and afterload hemodynamic parameters were observed in both the coronary artery disease and control group. Changes of preload parameters were sustained longer than those of afterload parameters, and were maintained until 20 minutes after the infusion. Afterload parameters (heart rate and cardiac output), were slowly normalized five minutes after the infusion. In the coronary artery disease group with antianginal medication, additive hemodynamic changes were also seen after the infusion, although the degree of changes were small. CONCLUSION: Following nicorandil infusion, both the preload and afterload hemodynamic parameters decreased, and the preload parameters showed a larger decrease for a longer period than the afterload parameters. In the coronary artery disease group with antianginal medication, additive hemodynamic changes were also seen following nicorandil infusion.
Angina Pectoris ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Artery Disease* ; Coronary Vessels* ; Hemodynamics* ; Humans ; Muscle, Smooth, Vascular ; Nicorandil* ; Nitroglycerin ; Potassium ; Pulmonary Artery*

Background: The novel sodium-glucose cotransporter-2 (SGLT2) inhibitor enavogliflozin effectively lowers glycosylated hemoglobin levels and body weights without the increased risk of serious adverse events; however, the long-term clinical benefits of enavogliflozin in terms of cardiovascular and renal outcomes have not been investigated. Methods: This study is an investigator-initiated, multicenter, randomized, pragmatic, open-label, active-controlled, non-inferiority trial. Eligible participants are adults (aged ≥19 years) with type 2 diabetes mellitus (T2DM) who have a history of, or are at risk of, cardiovascular disease. A total of 2,862 participants will be randomly assigned to receive either enavogliflozin or other SGLT2 inhibitors with proven cardiorenal benefits, such as dapagliflozin or empagliflozin. The primary endpoint is the time to the first occurrence of a composite of major adverse cardiovascular or renal events (Clinical Research Information Service registration number: KCT0009243). Conclusion This trial will determine whether enavogliflozin is non-inferior to dapagliflozin or empagliflozin in terms of cardiorenal outcomes in patients with T2DM and cardiovascular risk factors. This study will elucidate the role of enavogliflozin in preventing vascular complications in patients with T2DM.

Background: The novel sodium-glucose cotransporter-2 (SGLT2) inhibitor enavogliflozin effectively lowers glycosylated hemoglobin levels and body weights without the increased risk of serious adverse events; however, the long-term clinical benefits of enavogliflozin in terms of cardiovascular and renal outcomes have not been investigated. Methods: This study is an investigator-initiated, multicenter, randomized, pragmatic, open-label, active-controlled, non-inferiority trial. Eligible participants are adults (aged ≥19 years) with type 2 diabetes mellitus (T2DM) who have a history of, or are at risk of, cardiovascular disease. A total of 2,862 participants will be randomly assigned to receive either enavogliflozin or other SGLT2 inhibitors with proven cardiorenal benefits, such as dapagliflozin or empagliflozin. The primary endpoint is the time to the first occurrence of a composite of major adverse cardiovascular or renal events (Clinical Research Information Service registration number: KCT0009243). Conclusion This trial will determine whether enavogliflozin is non-inferior to dapagliflozin or empagliflozin in terms of cardiorenal outcomes in patients with T2DM and cardiovascular risk factors. This study will elucidate the role of enavogliflozin in preventing vascular complications in patients with T2DM.