Coronary stenting for long complex lesion is effective but associated with complication. We compared the results of stenting between with multiple conventional stenting group (group A) and with single long stenting group (group B). Fifty patients were prospectively and randomly enrolled: 25 patients for each group. Each group showed no significant differences of clinical characteristics. One patient died of heart failure in each group, not associated with the procedure itself. One patients had cerebrovascular accident in each group. Five patients had major bleeding (2, group A; 3, group B). Angiographic success rate was 100% in each group and procedural success rate was 96% and 100% in group A and B, respectively. Angiographic and clinical restenosis rate at 6 months follow-up were 60%, 36% in group A and 65%, 44% in group B, respectively (p=S). Multivariate analysis showed that several factors affected the angiographic restenosis rate as follows; a) male gender (M:F=76.9%:25.0%, P<0.001), b) AMI (AMI:stable angina pectoris=72.7%:66.7%, P<0.001), c) lesion length d) residual stenosis. In conclusion, there were no statistical differences of restenosis and complication rate between the two groups. Our data support single long stenting is acceptable and economically more favorable for long diffuse lesion, compared to multiple conventional stenting.
Constriction, Pathologic ; Coronary Stenosis* ; Coronary Vessels* ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Multivariate Analysis ; Prospective Studies ; Stents* ; Stroke

BACKGROUND: Hes6 is a transcriptional regulator that induces transcriptional activation by binding to transcription repressor Hes1 and suppressing its activity. Hes6 is controlled by the ubiquitin-proteosome-mediated degradation system. Here we investigated the sumoylation of Hes6 and its functional role in its rhythmic expression. METHODS: Hes6, SUMO, and ubiquitin were transfected into HeLa cells and the expression pattern was observed by Western blot and immunoprecipitation. To confirm the effect of sumoylation on the rhythmic expression of Hes6, we generated mouse Hes6 promoter-driven GFP-Hes6 fusion constructs and expressed these constructs in NIH 3T3 cells. RESULTS: Overexpression of SUMO led to sumoylation of Hes6 at both lysine 27 and 30. Protein stability of Hes6 was decreased by sumoylation. Moreover, expression of a Hes6 sumoylation-defective mutant, the 2KR (K27/30R) mutant, or co-expression of SUMO protease SUSP1 with native Hes6, strongly reduced ubiquitination. In addition, sumoylation was associated with both the rhythmic expression and transcriptional regulation of Hes6. Wild type Hes6 showed oscillatory expression with about 2-hour periodicity, whereas the 2KR mutant displayed a longer period. Furthermore, sumoylation of Hes6 derepressed Hes1-induced transcriptional repression. CONCLUSION: Hes6 sumoylation plays an important role in the regulation of its stability and Hes1-mediated transcription. These results suggest that sumoylation may be crucial for rhythmic expression of Hes6 and downstream target genes.
Animals ; Blotting, Western ; HeLa Cells ; Humans ; Immunoprecipitation ; Lysine ; Mice ; NIH 3T3 Cells ; Periodicity ; Protein Stability ; Proteolysis* ; Repression, Psychology ; Sumoylation* ; Transcriptional Activation ; Ubiquitin ; Ubiquitination

Purpose: To analyze the incidence and treatment costs associated with vision-threatening diabetic retinopathy (VTDR) in type 2 diabetes and to predict future VTDR populations and treatment expenditures. Methods: Using the data from the National Health Insurance Service from 2006 to 2017, we analyzed VTDR treatment costs by year, sex, and age. Based on the results and changes in future population distributions, we estimated the future number and cost of treatments for VTDR. Results: The number of treatments increased by 2.5-fold from 37,634 in 2006 to 96,214 in 2017, and treatment costs increased 3.4-fold from $13,528,587 in 2006 to $45,643,561 in 2017. When analyzed by year, age, and sex, all showed an increasing trend. Future number of treatments was estimated to increase from approximately 96,000 in 2017 to 220,000 by 2030 and treatment costs were projected to increase by 129% from about $45,643,561 in 2017 to about $1,043,055,262 by 2030. Conclusions As the incidence of VTDR rises due to an aging population and the frequency of intravitreal injections increases due to insurance reimbursement, future treatment expenditures for VTDR are expected to increase as well. Therefore, appropriate policies must be put in place now to secure medical and financial resources to manage VTDR and reduce medical expenditures in the future.

Purpose: We aimed to evaluate the clinical features of adolescents who visit emergency departments (EDs) with chest discomfort, and analyze the implications of underlying medical conditions for the development of cardiogenic chest discomfort. Methods: We reviewed the medical records of adolescents (13-18 years) with chest discomfort who visited a tertiary hospital ED in Seoul, Korea from 2014 through 2018. Sex, age, duration and character of the discomfort, symptoms and signs, ED length of stay, abnormal findings of vital signs, chest radiograph, electrocardiogram, and elevated concentrations of cardiac enzymes were reviewed. Final diagnosis was based on cardiac evaluations within 1 year after the index visit. Underlying medical conditions were defined as visits to the cardiology, pulmonology or hematology-oncology clinics at least twice in the preceding year. Initial suspicious clinical findings were defined as palpitation, syncope or high blood pressure. Logistic regression was used to identify predictors for cardiac etiology. Results: Of the 231 patients, 43 (18.6%) and 69 (29.9%) had underlying medical conditions and initial suspicious clinical findings, respectively. The predictors for cardiac etiology were underlying medical conditions (odds ratio, 4.28; 95% confidence interval, 1.09-16.73), initial suspicious clinical findings (4.77; 1.36-16.77), abnormal electrocardiogram (11.54; 3.22-41.32), and elevated concentration of troponin I (66.52; 5.37-823.55). The patients with cardiogenic chest discomfort had a longer median ED length of stay (281.0 minutes [interquartile range, 215.5-369.0] vs. 199.5 [132.8-298.0]; P = 0.004) and a higher hospitalization rate (48.3% vs. 13.4%; P < 0.001) than those with non-cardiogenic chest discomfort. Conclusion It may be necessary to recognize underlying medical conditions and initial suspicious clinical findings in EDs prior to cardiac evaluation in adolescents with chest discomfort.

Purpose: We aimed to evaluate the clinical features of adolescents who visit emergency departments (EDs) with chest discomfort, and analyze the implications of underlying medical conditions for the development of cardiogenic chest discomfort. Methods: We reviewed the medical records of adolescents (13-18 years) with chest discomfort who visited a tertiary hospital ED in Seoul, Korea from 2014 through 2018. Sex, age, duration and character of the discomfort, symptoms and signs, ED length of stay, abnormal findings of vital signs, chest radiograph, electrocardiogram, and elevated concentrations of cardiac enzymes were reviewed. Final diagnosis was based on cardiac evaluations within 1 year after the index visit. Underlying medical conditions were defined as visits to the cardiology, pulmonology or hematology-oncology clinics at least twice in the preceding year. Initial suspicious clinical findings were defined as palpitation, syncope or high blood pressure. Logistic regression was used to identify predictors for cardiac etiology. Results: Of the 231 patients, 43 (18.6%) and 69 (29.9%) had underlying medical conditions and initial suspicious clinical findings, respectively. The predictors for cardiac etiology were underlying medical conditions (odds ratio, 4.28; 95% confidence interval, 1.09-16.73), initial suspicious clinical findings (4.77; 1.36-16.77), abnormal electrocardiogram (11.54; 3.22-41.32), and elevated concentration of troponin I (66.52; 5.37-823.55). The patients with cardiogenic chest discomfort had a longer median ED length of stay (281.0 minutes [interquartile range, 215.5-369.0] vs. 199.5 [132.8-298.0]; P = 0.004) and a higher hospitalization rate (48.3% vs. 13.4%; P < 0.001) than those with non-cardiogenic chest discomfort. Conclusion It may be necessary to recognize underlying medical conditions and initial suspicious clinical findings in EDs prior to cardiac evaluation in adolescents with chest discomfort.

Purpose: Antivascular endothelial growth factor (anti-VEGF) agents are routinely intravitreously injected to treat neovascular age-related macular degeneration (AMD). Postoperative endophthalmitis, a side effect after intravitreal anti-VEGF injection, has been reported to have a low incidence but may threaten vision. In this study, we aimed to analyze the incidence of acute endophthalmitis after intravitreal anti-VEGF injection and associated risk factors in patients with neovascular AMD in South Korea. Methods: Using the health claims data recorded in the Korean National Health Insurance System database, we identified newly developed neovascular AMD cases from 2010 through 2019. Acute endophthalmitis was defined as a case of invasive treatment for accompanying symptoms. All statistical analyses were performed with a significance level p < 0.05. To find risk factors, we used univariate and multivariable Poisson regression. Results: The overall incidence of acute endophthalmitis was 0.019% (p = 0.21) during the 10-year period: 0.025% for aflibercept injection and 0.014% for ranibizumab injection. The incidence was higher in metropolitan city residents than in Seoul (incidence rate ratio [IRR], 1.96; 95% confidence interval [CI], 1.02–3.79; p = 0.04) and was higher for aflibercept injections than for ranibizumab injections (IRR, 1.82; 95% CI, 1.17–2.82; p = 0.01). However, in multivariate analysis, only aflibercept injections showed a significant effect on the incidence of acute endophthalmitis (IRR, 1.80; 95% CI, 1.16–2.79; p = 0.01). Conclusions The incidence of acute endophthalmitis after intravitreal anti-VEGF injections was generally low, and aflibercept was revealed as a significant risk factor.

The prevalence of human taeniasis has decreased in Korea. The stool egg positive proportion decreased from 1.9% in 1971 to 0% in 2004 in nationwide surveys. The neurocysticercosis (NCC) is also presumed to decrease. However, detailed information regarding the recent status of NCC in Korea is lacking. We retrospectively reviewed NCC cases from 1990 to 2016 at Asan Medical Center, a 2700-bed tertiary referral hospital in Korea. We identified patients based on clinical symptoms, brain imaging, pathology and serological assay. The cases were classified as parenchymal, extraparenchymal, and mixed NCC. Eighty-one patients were included in the analysis. The mean age was 54.5 years, and 79.0% were male. The number of NCC cases was highest from 1995 to 1999, and continuously decreased thereafter. Forty (49.4%) patients had parenchymal NCC, while 25 (30.9%) patients had extraparenchymal NCC, and 16 (19.8%) patients had mixed NCC. The seizure and headache were most common symptom of parenchymal NCC and extraparenchymal NCC respectively. Hydrocephalus was more common in extraparenchymal NCC, and patients with extraparenchymal NCC were more likely to require a ventriculoperitoneal shunt. Cases of NCC are decreasing accordingly with human taeniasis and lesion location was the most important determinant of clinical presentation and outcome of NCC in Korea.
Chungcheongnam-do ; Headache ; Humans ; Hydrocephalus ; Korea ; Male ; Neurocysticercosis ; Neuroimaging ; Ovum ; Pathology ; Prevalence ; Retrospective Studies ; Seizures ; Taenia solium ; Taeniasis ; Tertiary Care Centers ; Ventriculoperitoneal Shunt

Background: A laparoscopic approach is widely used in abdominal surgery. Although several studies have compared surgical and oncological outcomes between laparoscopic surgery (LS) and open surgery (OS) in rectal cancer patients, there have been few studies on postoperative renal outcomes. Methods: We conducted a retrospective cohort study involving 1,633 patients who underwent rectal cancer surgery between 2003 and 2017. Postoperative acute kidney injury (AKI) was diagnosed according to the serum creatinine criteria of the Kidney Disease: Improving Global Outcomes classification. Results: Among the 1,633 patients, 1,072 (65.6%) underwent LS. After matching propensity scores, 395 patients were included in each group. The incidence of postoperative AKI in the LS group was significantly lower than in the OS group (9.9% vs. 15.9%; p = 0.01). Operation time, estimated blood loss, and incidence of transfusion in the LS group were significantly lower than those in the OS group. Cox proportional hazard models revealed that LS was associated with decreased risk of postoperative AKI (hazard ratio [HR], 0.599; 95% confidence interval [CI], 0.402–0.893; p = 0.01) and postoperative transfusion was associated with increased risk of AKI (HR, 2.495; 95% CI, 1.529–4.072; p < 0.001). In the subgroup analysis, the incidence of postoperative AKI in patients with middle or high rectal cancer who underwent LS was much lower than in those who underwent OS (HR, 0.373; 95% CI, 0.197–0.705; p = 0.002). Conclusion This study showed that LS may have a favorable effect on the development of postoperative AKI in patients with rectal cancer.

BACKGROUND AND OBJECTIVES: To improve hearing screening, we developed a more effective hearing screening questionnaire for infants and children to be utilized during medical check-ups. SUBJECTS AND METHOD: Through literature review and discussions with an advisory council, we selected 10 questions to ask parents at each of the seven screening periods for their infants and children. In total, 223 parents of infants and children with and without hearing impairment (119 normal hearing, 104 hearing impaired) answered questionnaires at seven university hospitals in Korea. The advisory council modified questions with regard to sensitivity, specificity, positive, and negative prediction rate, preventing duplication among screening periods, and to address other questions related to development. RESULTS: For hearing screens, we asked five questions per screening period. Collectively, these questions had 40-100% sensitivity and 45-90% specificity at each of the seven screening periods. CONCLUSION: Although we do not advise that hearing questionnaires replace hearing tests, we developed in this study a more effective questionnaire that we suggest could be utilized during medical check-ups to enhance the hearing screening process.
Child* ; Hearing Loss ; Hearing Tests ; Hearing* ; Hospitals, University ; Humans ; Infant* ; Korea ; Mass Screening* ; Parents ; Sensitivity and Specificity

Background: This study aimed to evaluate whether fluvoxamine reduces clinical deterioration in adult patients with mild to moderate coronavirus disease 2019 (COVID-19), and to identify risk factors for clinical deterioration in patients admitted to a community treatment center (CTC). Materials and Methods: A randomized, placebo-controlled trial was conducted in a CTC, in Seoul, Korea from January 15, 2021, to February 19, 2021. Symptomatic adult patients with positive results of severe acute respiratory syndrome coronavirus 2 real timepolymerase chain reaction within 3 days of randomization were assigned at random to receive 100 mg of fluvoxamine or placebo twice daily for 10 days. The primary outcome was clinical deterioration defined by any of the following criteria: oxygen requirement to keep oxygen saturation over 94.0%, aggravation of pneumonia with dyspnea, or World Health Organization clinical progression scale 4 or greater. Results: Of 52 randomized participants [median (interquartile range) age, 53.5 (43.3 - 60.0) years; 31 (60.0%) men], 44 (85.0%) completed the trial. Clinical deterioration occurred in 2 of 26 patients in each group (P >0.99). There were no serious adverse events in either group. Clinical deterioration occurred in 15 (6.0%) of 271 patients admitted to the CTC, and all of them were transferred to a hospital. In multivariate analysis, age between 55 and 64, fever and pneumonia at admission were independent risk factors for clinical deterioration. Conclusion In this study of adult patients with symptomatic COVID-19 who were admitted to the CTC, there was no significant differences in clinical deterioration between patients treated with fluvoxamine and placebo (ClinicalTrials.gov Identifier: NCT04711863).