Background: White matter hyperintensity (WMH) is a risk factor for dementia and ischemic stroke. The atherogenic index of plasma (AIP) is a simple and cost-effective marker for the prediction of various vascular diseases. In this study, we evaluated the relationship between AIP and WMH in adults without cerebrovascular accidents. Methods: We analyzed the data of 281 adults, aged ≥26 years, who underwent brain magnetic resonance imaging (MRI) at the health promotion center of an education hospital between January 2014 and December 2018. Participants were divided into three categories according to tertiles of the AIP scores (T1: <0.20; T2: 0.20–0.48; and T3: >0.48). WMH was defined as a modified Fazekas scale score of 1–3 on brain MRI. A cubic spline curve was used to determine the linearity of the relationship between AIP and WMH. Multiple logistic regression analysis was used to evaluate the relationship between the AIP and WMH. Results: The prevalence of WMH was 45.7% in T1, 57.0% in T2, and 66.0% in T3 (T3 vs. T1, P for post-hoc analysis=0.005). The increased odds of WMH were associated with increased AIP. The odds ratio (OR) with a 95% confidence interval (CI) for WMH of T2 and T3 compared with T1 were 1.57 (0.88–2.80) and 2.30 (1.28–4.14), respectively. After adjusting for confounding variables, the OR with a 95% CI for WMH in the T2 and T3 groups vs. the referent T1 were 1.55 (0.76–3.13) and 2.27 (1.06–4.84), respectively. Conclusion AIP is independently and positively associated with WMH in a healthy population.

PURPOSE: Kawasaki disease can cause cardiovascular complications if not properly treated from the beginning. Recently, serum amyloid A(SAA) was reported to be a predictive factor of cardiovascular diseases. Therefore, it was examined whether the existence of coronary artery abnormality in Kawasaki disease can be predicted in acute stage. METHODS: Forty nine patients who were diagnosed with Kawasaki disease between October, 2006 and May, 2007 at Yonsei University, Wonju College of Medicine were selected for this study. We reviewed results of CBC, AST, ALT, CK, LDH, total bilirubin, albumin, CRP, CK-MB, troponin-I, LDL, HDL, SAA, ESR. We divided the patients into two groups: Group A consisting of patients with coronary artery lesions, and group B consisting of patients without coronary artery lesions. RESULTS: CRP was significantly higher in group A (group A 11.0+/-7.0 mg/dL vs group B 5.3+/-5.3 mg/dL, P=0.030). SAA was slightly higher in group A but did not show any statistical significance (group A 283.8+/-357.3 microgram/mL vs group B 133.2+/-293.4 microgram/mL, P=0.128). Binary regression analysis was used to identify the significance of SAA as a predictor of coronary artery abnormality but did not find any significance (SAA OR=1.000, 95% CI=0.998-1.002, P=0.950). CONCLUSION: SAA are not significant predictors of coronary artery abnormality in Kawasaki disease but are non specific factors which increase in the acute stage.
Amyloid ; Bilirubin ; Cardiovascular Diseases ; Coronary Vessels* ; Gangwon-do ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Serum Amyloid A Protein* ; Troponin I

OBJECTIVE: This study was performed to assess whether uterine intraendometrial or intramyometrial arterial blood flow impedance in Doppler sonography is related to the outcomes of IVF-ET cycles. METHODS: A total of 24 patients undergoing IVF-ET was recruited for the study. All patients received controlled ovarian hyperstimulation(COH) with GnRH agonist and gonadotropins. Doppler sonographic examinations were performed by using Combison 530(Medison) with 5.5 MHz transvaginal probe. Pulsatility index(PI) was evaluated for uterine, radial, and spiral arteries on the days of hCG administration, oocyte retrieval, and embryo transfer(ET). Serum E2 level was assayed on the hCG day. RESULTS: The overall pregnancy rate after IVF-ET was 29.2%(7/24). There was no significant difference in PI of uterine artery between pregnant and nonpregnant groups, No pregnancy occurred in 4(16.7%) patients without intraendometrial or subendometrial blood flow. Compared with nonpregnant group, PI of radial artery on the hCG day and PI of spiral artery on the hCG and oocyte retrieval days were significantly lower in pregnant group. There were no significant correlations between Serum E level on the hCG day and Pl of any three arteries. CONCLUSION: This study suggests that the Doppler sonographic parameter, PI, of intraendometrial and intramyometrial arteries are more useful than that of uterine artery not only in predicting the success of IVF-ET, but also in assessing the endometrial receptivity.
Arteries* ; Electric Impedance ; Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro* ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Oocyte Retrieval ; Pregnancy Rate ; Pregnancy* ; Radial Artery ; Serum ; Ultrasonography ; Ultrasonography, Doppler* ; Uterine Artery

PURPOSE: To identify differences in ultrasonography (US) feature, clinical and pathological characteristics including immunohistochemical characteristics between small breast cancer (pathologic size ≤ 5 mm) and large breast cancer (> 5 mm). MATERIALS AND METHODS: A total of 528 invasive breast cancer lesions in 475 patients were included. US features with clinical and pathological characteristics were evaluated according to pathologic size. US Breast Imaging-Reporting and Data System findings and final assessments were recorded for each lesion. Standard references were based on surgical pathologies. RESULTS: Of 528 invasive breast cancer lesions, 62 were small breast cancers. Small breast cancers showed a higher rate of oval, round shape, parallel orientation; circumscribed margin; and iso/solid and cystic echo pattern, with no posterior feature. The final assessment of category 4 was also a dominant factor in small breast cancer. Early stage, asymptomatic state, and extensive ductal carcinoma in situ component were associated with small breast cancers. CONCLUSION Our results show that small breast cancers have less suspicious US features than large breast cancers.

OBJECTIVE: The change of claudin expressions, integral transmembrane proteins for tight junction, might be related to progression of cervical premalignancy or malignancy. The aim of this study was to verify the tendency of expressions of claudin-1 and -7 according to the progression of cervical pathology of uterus. METHODS: There were 162 tissues obtained at AA institute. 25 tissues were normal, 26 were cervical intraepithelial neoplasia (CIN) 1, 30 were CIN2, 44 were CIN3, 25 were microinvasive cervical carcinomas, and 12 were invasive squamous cervical carcinomas (ISCC). H and E and immunohistochemical staining were done. RESULTS: Among normal tissues, 52% showed no expression, 48% weak expressions at claudin-1, and 28% no expression, 56% weak expressions at claudin-7. Among CIN3, 20% showed weak expressions, 41% showed moderate expressions at claudin-1, and 14% weak expressions, 52% moderate expressions at claudin-7. Among ISCC, 42% showed moderate expressions, 50% strong expressions at claudin-1, and 33% moderate expressions, and 33% strong expressions at claudin-7. These data shows the increasing tendency of claudin-1 and claudin-7 expressions according to the severity of lesions (p<0.01). CONCLUSION: The expressions of claudin-1 and claudin-7 were increased more according to the progression of cervical lesions.
Carcinoma, Squamous Cell* ; Cervical Intraepithelial Neoplasia ; Claudin-1* ; Pathology ; Tight Junctions ; Uterus

OBJECTIVE: The change of claudin expressions, integral transmembrane proteins for tight junction, might be related to progression of cervical premalignancy or malignancy. The aim of this study was to verify the tendency of expressions of claudin-1 and -7 according to the progression of cervical pathology of uterus. METHODS: There were 162 tissues obtained at AA institute. 25 tissues were normal, 26 were cervical intraepithelial neoplasia (CIN) 1, 30 were CIN2, 44 were CIN3, 25 were microinvasive cervical carcinomas, and 12 were invasive squamous cervical carcinomas (ISCC). H and E and immunohistochemical staining were done. RESULTS: Among normal tissues, 52% showed no expression, 48% weak expressions at claudin-1, and 28% no expression, 56% weak expressions at claudin-7. Among CIN3, 20% showed weak expressions, 41% showed moderate expressions at claudin-1, and 14% weak expressions, 52% moderate expressions at claudin-7. Among ISCC, 42% showed moderate expressions, 50% strong expressions at claudin-1, and 33% moderate expressions, and 33% strong expressions at claudin-7. These data shows the increasing tendency of claudin-1 and claudin-7 expressions according to the severity of lesions (p<0.01). CONCLUSION: The expressions of claudin-1 and claudin-7 were increased more according to the progression of cervical lesions.
Carcinoma, Squamous Cell* ; Cervical Intraepithelial Neoplasia ; Claudin-1* ; Pathology ; Tight Junctions ; Uterus

The objective of this study was to develop a pre-clinical large animal model for the in vivo hemodynamic testing of prosthetic valves in the aortic position without the need for cardiopulmonary bypass. Ten male pigs were used. A composite valved conduit was constructed in the operating room by implanting a prosthetic valve between two separate pieces of vascular conduits, which bypassed the ascending aorta to the descending aorta. Prior to applying a side-biting clamp to the ascending aorta for proximal grafting to the aortic anastomosis, an aorta to femoral artery shunt was placed just proximally to this clamp. The heart rate, cardiac output, Vmax, transvalvular pressure gradient, effective orifice area and incremental dobutamine stress response were assessed. A dose dependant increase with dobutamine was seen in terms of cardiac output, Vmax, and the peak transvalvular pressure gradient both in the native and in the prosthetic valve. However, the increment was much steeper in the prosthetic valve. No significant differences in cardiac output were noted between the native and the prosthetic valves. The described pre-clinical porcine model was found suitable for site-specific in-vivo hemodynamic assessment of aortic valvular prosthesis without cardiopulmonary bypass.
Adrenergic beta-Agonists/pharmacology ; Animals ; Aorta/pathology ; Aortic Valve/*pathology ; Disease Models, Animal ; Dobutamine/pharmacology ; Dose-Response Relationship, Drug ; Heart Rate ; *Heart Valve Prosthesis ; Male ; Pressure ; *Prosthesis Implantation ; Support, Non-U.S. Gov't ; Swine ; Thoracic Arteries/pathology

BACKGROUND/AIMS: Because detection and removal of colonic adenoma provided an opportunity to prevent colorectal cancer, advanced adenoma (>10 mm, villous or high grade dysplasia) should be the major target of screening. In this study, we assessed the diagnostic sensitivity of one- or two-time immunochemical fecal occult blood test (i-FOBT), flexible sigmoidoscopy and their combination in patients with advanced adenoma or non-advanced adenoma. MEHTODS: From January to October 2002, we performed colonoscopy with i-FOBT using latex agglutination method in 879 individuals. Among these, we diagnosed 234 polyps in 93 patients with advanced adenoma and 179 polyps in 109 patients with non-advanced adenoma. After the diagnosis of adenoma, second i-FOBT was done before polypectomy. Based on these data, we evaluated the diagnostic sensitivities of i-FOBT, flexible sigmoidoscopy and their combination for patients with advanced adenoma or non-advanced adenoma. RESULTS: The diagnostic sensitivity of one- or two-time i-FOBT, flexible sigmoidoscopy and flexible sigmoidoscopy with two-time i-FOBT in patients with advanced adenoma vs.non-advanced adenoma were 17.2% vs. 18.3%, 28.0% vs. 29.4%, 70.1% vs. 66.1% and 81.7% vs. 78.0%. Although repeated application of i-FOBT enhanced diagnostic sensitivity for colon adenoma, this test or combination with flexible sigmoidoscopy did not differentiate advanced adenoma from non-advanced adenoma. CONCLUSIONS: Although it fails to detect one fifth of colon adenoma, combined two-time i-FOBT testing with flexible sigmoidoscopy is an effective and feasible screening modality for advanced colon adenoma.
Adenoma* ; Agglutination ; Colon* ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis ; Humans ; Latex ; Mass Screening ; Occult Blood ; Polyps ; Sigmoidoscopy*

PURPOSE: We identified pediatric liver transplant recipients with successful withdrawal of immunosuppression who developed tolerance in Korea. MATERIALS AND METHODS: Among 105 pediatric patients who received liver transplantation and were treated with tacrolimus-based immunosuppressive regimens, we selected five (4.8%) patients who had very low tacrolimus trough levels. Four of them were noncompliant with their medication and one was weaned off of immunosuppression due to life threatening posttransplant lymphoproliferative disorder. We reviewed the medical records with regard to the relationship of the donor-recipients, patient characteristics and prognosis, including liver histology, and compared our data with previous reports. RESULTS: Four patients received the liver transplantation from a parent donor and one patient from a cadaver donor. A trial of withdrawal of the immunosuppressant was started a median of 45 months after transplantation (range, 14 months to 60 months), and the period of follow up after weaning from the immunosuppressant was a median of 32 months (range, 14 months to 82 months). None of the five patients had rejection episodes after withdrawal of the immunosuppression; they maintained normal graft function for longer than 3 years (median, 38 months; range, 4 to 53 months). The histological findings of two grafts 64 and 32 months after weaning-off of the medication showed no evidence of chronic rejection. CONCLUSION: The favorable markers for successful withdrawal of immunosuppression were 1) long-term (> 3 years) stable graft function, 2) no rejection for longer than 1 year after withdrawal of immunosuppression, 3) non-immune mediated liver diseases, and 4) pediatric patients.
Child ; Child, Preschool ; Female ; Humans ; Immunosuppressive Agents/*administration & dosage/therapeutic use ; Infant ; Korea ; Liver/pathology ; Liver Transplantation/*immunology/*methods ; Male ; Postoperative Complications/*drug therapy/immunology ; Tacrolimus/*administration & dosage/therapeutic use

PURPOSE: To determine the long-term patency of percutaneous intravascular metallic stent placement in patients with chronic iliac artery stenosis. MATERIALS AND METHODS: Intravascular metallic stents were placed percutaneously in 41 limbs of 38 patients with chronic iliac artery stenosis who presented with intermittent claudication in 40 limbs and gangrene in the other. Preoperative angiography showed that complete occlusion occurred in one limb, and luminal stenosis of over 50% in 34 and of less than 50% in six. The mean length of stenoses was 3.1 (range, 1 -8) cm, and in all cases the systolic pressure gradient was over 10 (range, 12 -100, mean, 43) mmHg. Stent placement was indicated by failed balloon angioplasty in 35 limbs, primary stenting in five, and restenosis after balloon angioplasty in one. Technical and clinical success were evaluated in terms of immediate results and stent patency over a period of 1 -49 (mean, 19) months (Kaplan-Meier method). RESULTS: Stent placement was successful in all cases in which residual stenosis was less than 10% and systolic pressure gradient less than 2 mmHg. One to three days after the procedure, clinical symptoms had improved in 40 limbs and ABI (n=23) had increased from 0.64 +/-0.20 to 0.92 +/-0.17. Follow-up studies demonstrated patency rates of 94.1% at 6 months, 90.7% at 1 year, 86.6% at 2 years, and 86.6% at 4 years. CONCLUSION: Our results showed that in patients with chronic iliac artery stenosis, percutaneous intravascular metallic stent placement led to patency rates which were similar over a period of between six months and four years.
Angiography ; Angioplasty, Balloon ; Blood Pressure ; Constriction, Pathologic* ; Extremities ; Follow-Up Studies ; Gangrene ; Humans ; Iliac Artery* ; Intermittent Claudication ; Phenobarbital ; Stents*