BACKGROUND: Exaggerated blood pressure (BP) response to exercise can be an independent risk factor for cardiovascular mortality and morbidity. The purpose of this study was to define the factor that effect on early systolic BP response to exercise. METHODS: We examined echocardiographic data, BP, heart rate from graded exercise test and brachial ankle pulse wave velocity (PWV) of 205 patients (137 men and 68 women; mean age 58 +/- 11 years; range, 19 to 83 years). Graded exercise test was conducted in BRUCE protocol. We define delta systolic blood pressure (SBP) as systolic BRUCE stage "n" BP minus baseline BP. RESULTS: Resting BP (127 +/- 16 mm Hg) was elevated to 171 +/- 26 mm Hg after peak graded exercise test. Resting heart rate (80 +/- 15 bpm) was increased to 146 +/- 27 bpm after peak graded exercise test. Stepwise regression test between baseline SBP, delta SBP, maximal SBP and left atrial volume index (LAVI) was done. Supine SBP, delta SBP, maximal SBP was not associated with LAVI (p > 0.5). But increased LAVI was significantly associated with delta SBP1 in woman (R2 = 0.192, p = 0.002). PWV was significantly associated with base line (R2 = 0.311, p < 0.01) and maximal SBP (R2 = 0.051, p < 0.01). However, PWV was not associated with delta SBP. CONCLUSIONS: LAVI and PWV were not associated with early SBP response to exercise. But in women, elevation of early SBP during exercise is associated with LAVI.
Blood Pressure* ; Exercise Test* ; Female ; Heart Rate* ; Heart ; Humans ; Male ; Pulse Wave Analysis* ; Risk Factors

BACKGROUND/AIMS: The aim of this study was to compare palliative treatments such as chemotherapy, chemoradiotherapy or radiotherapy with best supportive care in patients with inoperable advanced esophageal cancer. METHODS: A total of 67 patients with inoperable advanced esophageal cancer visiting Kosin University Gospel Hospital between January 2000 and July 2010 were included in a retrospective analysis. Patients were categorized as having palliative treatment or best supportive care to compare their prognosis. RESULTS: The median survival was 6.4 months in 67 patients. There was significant difference in median survival between the palliative and best supportive treatment (9.8 months vs. 4.5 months, p=0.01). The patients who underwent palliative treatment had superior 1-year and 3-year overall survival rate than those with best supportive treatment (27%, 10% vs. 5%, 5%, respectively). The 1-year and 3-year overall survival rate of palliative treatment was 18% (1-year overall survival rate) in chemotherapy, 33% (1-year overall survival rate) in radiotherapy, 45% and 9% in concurrent chemoradiotherapy, and 20% and 20% in sequential chemoradiotherapy, respectively. CONCLUSIONS: These results may suggest that palliative treatments are more effective than best supportive care. Further prospective studies are still needed to elucidate beneficial effect of palliative treatments on inoperable advanced esophageal cancer.
Aged ; Aged, 80 and over ; Combined Modality Therapy ; Esophageal Neoplasms/mortality/*therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; *Palliative Care ; Prognosis ; Retrospective Studies

The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.
Crime ; Data Collection ; Female ; Fires ; Forensic Medicine ; Forensic Sciences ; Humans ; Male ; Skeleton ; Statistics as Topic

BACKGROUND: The major cause of metabolic syndrome and diabetes is reduced cellular performances in fuel metabolism, but the underlying pathways and mechanisms are not completely understood. Dysregulation of energy homeostasis can lead to metabolic disturbances and it predisposes diabetes, cardiovascular disease, aging, and cancer. CR6-interacting factor 1 (CRIF1) contacts coiled-coil domain that is required for both genomic stability and mitochondrial integrity. We performed this study to determine the role of CRIF1 on the mice hearts. METHODS: CRIF1-deficient mouse was embryonic lethal and we made heart specific CRIF1-deficient mouse using Cre-loxP system. We made thoracotomy and directly injected adeno-Cre virus into the heart of CRIF1-loxP mice. Beta-gal virus was used as a control. RESULTS: Serial echocardiography showed decreased left ventricular ejection fraction and fractional shortening in the CRIF1-deficient mice at four and seven weeks later compared to wild type mice (p < 0.05). H&E showed increased myocardial inflammation in the CRIF1-deficient mice. Terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling staining and LC3 staining showed increased apoptosis and autophage in CRIF1-deficient mice compared with wild type (p < 0.01). Electron microscopy revealed that the mitochondria in CRIF1-deficient cardiomyocytes showed abnormal morphogenesis. For example, the cells showed excessively fragmented mitochondria, intracristal swelling, and thinning of myocardial fiber. The stability of mitochondrial complexes in CRIF1-deficient cells showed marked derangements. CONCLUSIONS: CRIF1 is required for maintenance of normal mitochondrial function and modulate apoptosis and autophagy in the heart.
Aging ; Animals ; Apoptosis ; Autophagy ; Cardiovascular Diseases ; Cell Cycle Proteins ; DNA Nucleotidylexotransferase ; Echocardiography ; Genomic Instability ; Heart ; Heart Failure ; Homeostasis ; Inflammation ; Mice ; Microscopy, Electron ; Mitochondria ; Mitochondria, Heart ; Morphogenesis ; Myocytes, Cardiac ; Stroke Volume ; Thoracotomy ; Viruses

BACKGROUND/AIMS: The delay between the onset of myocardial infarction symptoms and primary percutaneous coronary intervention (PCI) is an important prognostic factor in patients with ST-segment elevation acute myocardial infarction (STEMI). We reviewed this delay in patients with STEMI and analyzed clinical outcomes. METHODS: The study enrolled 3,399 patients (age, 61.4 +/- 12.8 years; 25.6% women) with STEMI who underwent primary PCI within 12 hours of symptom onset between October 2005 and February 2008 from the Korea Acute Myocardial Infarction Registry. The patients were divided into two groups according to the symptom-to-balloon time: group I (< or = 3 hours, n = 955) and group II (> 3 hours, n = 2444). The in-hospital mortality rates and 1-year mortality and major adverse cardiac event (MACE) rates were compared between the two groups. RESULTS: The mean time interval from the onset of symptoms to arrival at the emergency room (ER) was 188.0 +/- 133.6 minutes (median, 152 minutes). The mean time interval from the ER to reperfusion (door-to-balloon time) was 97.8 +/- 67.9 minutes (median, 80 minutes). The mean time interval from the onset of symptoms to reperfusion (symptom-to-balloon time) was 285.8 +/- 146.2 minutes (median 250 minutes). The in-hospital mortality rate was significantly lower in group I as compared with group II (3.6% versus 5.2%, p = 0.044). The 1-year mortality rate was also significantly lower in group I (4.7% versus 7.2%, p = 0.012), while the 1-year MACE rate was not significantly different between groups (17.9% versus 20.4%, p = 0.179). CONCLUSIONS: This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI in Korea and this time delay is associated with increased 1-year mortality.
Angioplasty ; Emergencies ; Hospital Mortality ; Humans ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Reperfusion ; Time Factors

PURPOSE: In order to clarify the correlation of mandibular setback using bilateral intraoral vertical ramus osteotomy (BIVRO) and post-surgical transverse mandibular width (TMW), this study examined the pre- and postsurgical changes in hard and soft tissues of TMW and the relationship of TMW and the amount of mandibular setback. PATIENTS AND METHODS: One-hundred seven patients who had undergone BIVRO were evaluated radiographically and clinically. A comparison study of the changes in hard and soft tissue after surgery in all 107 patients was performed with preoperative, 1 month, 3 month, 6 month and 1 year postoperative posteroanterio cephalograms and clinical photographs by tracing. And this changes were evaluated in parts to amounts of mandibular setback. RESULTS: Statistically significant increases of TMW in hard and soft tissue from preoperative to postoperative 1 month were seen. TMW in hard tissue from 1 month to 1 year postopertive were gradually decreased. TMW in soft tissue was not changed uniformly but almost equal to pre-operative width. And there was no significant correlation between TMW and amount of mandibular setback. CONCLUSIONS: The results show that mandibular setback using BIVRO did not significantly influence increasing of TMW in soft tissue.
Humans ; Osteotomy*

PURPOSE: We wanted to evaluate the value of abdominal aortic calcification (AAC), as detected on CT, as a predictor of atherosclerotic stenotic disease of the lower extremity arteries. MATERIALS AND METHODS: One hundred three patients who had CT angiography performed for the evaluation of peripheral vascular disease were enrolled in this retrospective study. The volume (mm3) of the AAC was measured on CT. Each lower extremity was divided into 8 segments. The extent of stenosis of the lower extremity artery was manifested as the sum of the stenosis scores for 16 segments (total stenosis score: TSS). The significant stenosis scores (SSS-50 and SSS-75) were defined as the sum of scores for the lower extremity artery segments that had significant stenosis of more than 50% and 75%, respectively. AAC was correlated to the TSS, SSS-50 and SSS-75 with using Spearman's correlation coefficient. The diagnostic performance of AAC for stenosis of a lower extremity artery of more than 50% and 75%, respectively, was evaluated by using the receiver operating characteristic (ROC) curve RESULTS: The Spearman's correlation coefficients were 0.728 (AAC vs. TSS), 0.662 (AAC vs. SSS-50), and 0.602 (AAC vs. SSS-75), respectively. For significant stenosis more than 50% and 75%, the areas under the ROC curve were 0.898 and 0.866, respectively. The cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 1030 mm3, 87%, 88%, 89%, 86% and 87% for stenosis more than 50% and 1030 mm3, 87%, 80%, 79%, 88% and 84% for stenosis more than 75%, respectively. CONCLUSION: Abdominal aortic calcification detected on CT may be a useful predictor of atherosclerotic stenotic disease of lower extremity arteries.
Angiography ; Arteries ; Constriction, Pathologic ; Humans ; Lower Extremity ; Mass Screening* ; Peripheral Vascular Diseases* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

PURPOSE: A symptomatic renal calyceal diverticular stone is a rare occurrence. Endourologic techniques, including laparoscopy, retrograde ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL) have been used for the treatment of this disease. Herein, we reviewed our experiences of treating stones in calyceal diverticulum with URS or PNL. MATERIALS AND METHODS: We retrospectively reviewed 23 patients who underwent PNL (12 cases) or URS (11 cases) for the treatment of symptomatic calyceal diverticular stones. A direct target puncture of the diverticulum was made in the PNL group and a flexible or semi-rigid ureteroscope was used to reach the diverticulum in the URS group. The diverticular neck was either incised with Holmium:YAG laser or dilated. Extracorporeal shockwave lithotripsy (ESWL) was performed prior to the procedure in 9 of the 23 cases (2 in the PNL group and 7 in the URS group). RESULTS: A complete stone-free state, with symptomatic resolution, was obtained in 11 of the 12 in the PNL group and in 7 of the 11 in the URS group. Success in the PNL group depended on an accurate puncture into the diverticulum and successful placement of the nephrostomy catheter into the renal pelvis through the diverticular neck. Success with the URS was achieved when the ureteroscope passed into the diverticulum and the double-J stent had been optimally placed. Seven of the 9 cases with prior ESWL achieved a stone-free state, while all the prior ESWL cases with successful access achieved a stone-free state. CONCLUSIONS: A calyceal diverticular stone can be treated with PNL or URS in most cases, although they are technically challenging procedures. In both procedures, access into the diverticulum is the most important step for a successful outcome. If access can be gained, preoperative ESWL could facilitate clearance of the stone and reduce the operating time, as there is no need for intraoperative lithotripsy.
Calculi ; Catheters ; Diverticulum ; Humans ; Kidney Pelvis ; Laparoscopy ; Lithotripsy ; Neck ; Nephrostomy, Percutaneous ; Punctures ; Retrospective Studies ; Stents ; Ureteroscopes ; Ureteroscopy

Ectopic tooth is not uncommon and usually occurs in the palate and maxillary sinus. We report a case of ectopic tooth located in the nasal cavity, a rare site. The mass depicted by CT was highly attenuated, and central lucency was observed.
Maxillary Sinus ; Nasal Cavity ; Palate ; Tooth*

PURPOSE: To evaluate the efficacy of MR cholangiography for follow-up examination after metallic stent placement in the bile duct. MATERIALS AND METHODS: Between December 1999 and June 2000, 15 patients with biliary obstruction in whom metallic biliary stents had been placed underwent MR cholangiography during follow-up examination. The causes of obstruction were hilar cholangiocarcinoma (n=6), common bile duct cancer (n=5), gall bladder cancer (n=1) and pancreatic cancer (n=3). The types of self-expandable metallic stent employed were the nitinol stent (n=2), the Endocoil nitinol stent (n=3), the Ultraflexed Diamond stent (n=5), and the Wallstent (n=5). Using MR cholangiography, we measured the diameter of that part of the biliary stent which showed high signal intensity, assigning one point if this was less than one third of the stent diameter, two points if between one third and two thirds, and three points if more than two thirds. We decided that a higher score indicated fewer artifacts. RESULTS: The score was 1.7-3 (mean, 2.3) points for the Endocoil nitinol stent, 1.7-2.3 (mean, 2) for the nitinot stent, and 1-3 (mean, 1.7) for the Ultraflex Diamond stant. In most cases, two thirds of the stent diameter was observed. For the Wallstent, the score was 1-1.7 (mean, 1.3) points and the inner portion of the stent was almost invisible. CONCLUSION: MR cholangiography is not useful for follow-up examination after the placement of Wallstents and three other types of nitinol stent in the bile duct.
Artifacts ; Bile Ducts* ; Bile* ; Cholangiocarcinoma ; Cholangiography* ; Common Bile Duct ; Diamond ; Follow-Up Studies* ; Gallbladder Neoplasms ; Humans ; Pancreatic Neoplasms ; Stents*