Cyclosporine(CsA) has been known to cause an endothelial dysfunction following its use as an immunosuppressive agent. On the other hand, the vascular endothelium has been recognized as an endocrine organ in its own right, i.e., it releases vasoactive factors such as nitric oxide(NO) and hyperpolarizing factor(EDHF). NO is synthesized by at least three isoforms of NO synthases(NOS), among which ecNOS is constitutively expressed in the endothelium. The principle of EDHF has not been determined. The present study was aimed at further investigating the mechanisms underlying the CsA-induced vasculopathy. Rats were treated with CsA (25mg/kg/day, subcutaneous) for one week and their thoracic aortae were isolated. Their changes of iso-metric tension in responses to acetylcholine, diazoxide, and high concentrations of calcium were recorded. The expression of ecNOS mRNA and protein was determined by reverse transcription-polymerase reaction and Western blot analysis, respectively. The acetylcholine-induced relaxation of the aortic rings was significantly diminished follawing the CsA-treatment, which was prevented by L-arginine supplemented along with the CsA-treatment. The relaxation of the thoracic aorta in response to either diazoxide or high concentrations of extracellular calcium was not affected by CsA-treatrnent. The vascular tissue contents of NO metabolites were significantly decreased following the CsA-treatment, which was also prevented by L-arginine-supple-mentation. Neither ecNOS mRNA nor protein expression was significantly altered following the CsA-treatment. It is suggested that CsA induces an endothelial dysfunction, which cannot be attributed to an altered role of EDHF, but to an impairment in L-arginine/NO pathway at the steps beyond NOS protein expression.
Acetylcholine ; Animals ; Aorta, Thoracic ; Arginine ; Blotting, Western ; Calcium ; Diazoxide ; Endothelium ; Endothelium, Vascular ; Hand ; Protein Isoforms ; Rats* ; Relaxation ; RNA, Messenger

No abstract available.
Facial Bones* ; Humans

OBJECTIVES: Nasal continuous positive airway pressure (nCPAP) is the treatment of choice and has been shown to reduce the frequency of nocturnal respiratory events, improve sleep architecture, and decrease daytime sleepiness in patients with obstructive sleep apnea syndrome (OSAS). However, little is known about the compliance of nCPAP treatment in Korea. Our objective was to look into the nCPAP compliance and examine the factors influencing it. METHODS: We reviewed the records of one hundred and twenty consecutive patients with OSAS referred for nocturnal polysomnography with nCPAP pressure titration during the period of January 1995 through April 1999 to the Seoul National University Hospital. We performed a telephone interview and obtained data from eighty-three patients. RESULTS: In sixty patients who had accepted nCPAP treatment, twenty-six patients (43.3%) were still using nCPAP device, while thirty-four patients (56.7%) stopped using it. Fifteen patients (25%) were using nCPAP device everyday. In thirty-four patients who discontinued nCPAP use, twenty-five patients (73.5%) did within the first three months, and thirty-one (91.2%) within the first year. Significant predictor of long-term nCPAP use was the presence of subjective daytime sleepiness before nCPAP application. CONCLUSIONS: Long-term compliance with nCPAP treatment appears to be associated with the presence of subjective daytime sleepiness before nCPAP application. Long-term compliance with nCPAP may be mostly predicted from the usage pattern within the first three months of use.
Compliance* ; Continuous Positive Airway Pressure* ; Humans ; Interviews as Topic ; Korea ; Polysomnography ; Seoul ; Sleep Apnea, Obstructive*

The present study was aimed at investigating the effect of cyclosporine A (CsA) on the renal renin-angiotensin systems. In rats chronically treated with CsA, the intrarenal expression of various genes of the renin-angiotensin system was assessed by Northern blot analysis. Along with the increases in plasma and renal renin activities, chronic CsA-treatment differentially affected the renal expression of renin-angiotensin system. The treatment with CsA for one week did not significantly alter the expression of either type 1 angiotensin II receptor (AT1A) or angiotensinogen gene, but increased the renin mRNA level. The three-week-treatment caused increases in the expression not only of renin but also of AT1A and angiotensinogen genes. Supplementation with L-arginine kept the expression of renin mRNA normal in the one-week-treated, but failed to prevent the alterations of the gene expression in the three-week-treated. Feedback control among components of the renin-angiotensin system also influences angiotesinogen. In the liver, the expression of angiotensinogen mRNA was decreased by the CsA-treatment for either one- or three-weeks. In conclusion, chronic CsA-treatment is associated with a differential expression of various genes for the renin-angiotensin system. L-Arginine may be effective in maintaining the normality of renin-angiotensin system only during early period after beginning the use of CsA.
Angiotensinogen ; Animals ; Arginine ; Blotting, Northern ; Cyclosporine* ; Gene Expression ; Liver ; Plasma ; Rats ; Receptors, Angiotensin ; Renin ; Renin-Angiotensin System* ; RNA, Messenger

OBJECTIVES: This study was designed to investigate the prevalence of depressive symptoms in patients with breast cancer and to identify demographic variables and clinical characteristics impact on depressive symptoms and health related quality of life in patients with breast cancer in a university hospital. METHODS: Fourty-one patients with breast cancer were selected, who had visited the department of General surgery of the Wonkwang University hospital with a diagnosis of breast cancer regularly during the period November, 2010-May, 2011. All of subjects were evaluated for the depression, anxiety and the health related quality of life with Beck Depression Inventory(BDI), anxiety subscale of Personality Assessment Inventory(PAI) and Short-Form 36 Health Survey-Korean version(SF-36-K). Patients were divided into depressive symptoms and non-depressive symptoms group according to the BDI score. We compared SF-36-K between two groups, and analized multiple regression with depression and health related quality of life as criterion variables and demographic and clinical characteristics. RESULTS: The prevalence of depression in patients with breast cancer in a University hospital was 36.4%. Compared to the non-depression, depressed patients with breast cancer appeared significantly lower mean scores on six subscales in SF-36-K : Physical function(p<.01), Role-physical(p<.001), General health(p<.05), Social function(p<.001), Role-emotional(p<.001) and Mental health(p<.001). But there was no significant difference between two groups in Vitality and Bodily pain. Anxiety, level of education and presence of enforcement of chemotherapy(63.6%) were significant explanation variables for depressive symptoms. And type of surgery and age (55.8%) were significant explanation variables for health related quality of life. CONCLUSIONS: The prevalence of depressive symptoms in patients with breast cancer in a University hospital was 36%. The depressive symptoms had not only negative impact on the health related quality of life but also important explanation variable for health related quality of life. These results suggest that depressive symptoms in patients with breast cancer should be evaluated and treated for improving patient's health related quality of life.
Anxiety ; Breast ; Breast Neoplasms ; Depression ; Humans ; Personality Assessment ; Prevalence ; Quality of Life

We evaluated MR imaging of spondylolytic spondylolisthesis degenerative spondylolisthesis and retrolisthesis in 14, 9 and 20 patients respectively. Sagittal and axial spin echo and gradient echo images were obtained with 25-30cm FOV and 5mm/0.5mm thickness/gap by using spine surface coil. Sagittal images showed defects of pars interarticularis just inside of the pedicles of spines in all the cases of spondylolytic spondylolisthesis with relatively variable signal intensity. Displaced vertebrae were commonly observed at L5 (8/14) in spondylolytic spondylolisthesis, at L4 (5/9) in degenerative spondylolisthesis and at variable locations in retrolisthesis. The mean length of displacement of vertebrae in spondylolytic spondylolisthesis was about 7mm and less displacement was onserved in degenerative spondylolisthesis and retrolisthesis. Seven, four and six cases of pseudobulging of disk at displaced level were observed in cases of spondylolytic spondylolisthesis, degenerative spondylolisthesis and retrolisthesis respectively. Seven, five and 14 cases of true disk lesions were onserved in cases of spondylolytic spondylolisthesis, degenertive spondylolisthesis and retrolisthesis respectively. Grade II neural foraminal stenoses (obliteration of one half epidural fat of neural foramen) were commonly (8/14) seen in spondylolytic spondylolisthesis, however the other two types showed less severe neural foraminal stenosis. In conclusion, MR imaging is a highly accurate method for the diagnosis and evaluation of spondylolisthesis and associated lesions of spine and disks.
Constriction, Pathologic ; Diagnosis ; Humans ; Magnetic Resonance Imaging* ; Methods ; Spine ; Spondylolisthesis*

No abstract available.
Nasal Cavity* ; Neurilemmoma*

Nitric oxide has been implicated in many physiologic processes that influence both acute and long-term control of kidney function. Its net effect in the kidney is to promote natriuresis and diuresis, contributing to adaptation to variations of dietary salt intake and maintenance of normal blood pressure. A pretreatment with nitric oxide donors or L-arginine may prevent the ischemic acute renal injury. In chronic kidney diseases, the systolic blood pressure is correlated with the plasma level of asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase. A reduced production and biological action of nitric oxide is associated with an elevation of arterial pressure, and conversely, an exaggerated activity may represent a compensatory mechanism to mitigate the hypertension.
Acute Kidney Injury ; Arginine ; Arterial Pressure ; Blood Pressure ; Diuresis ; Hypertension ; Kidney ; Natriuresis ; Nitric Oxide ; Nitric Oxide Donors ; Nitric Oxide Synthase ; Plasma ; Renal Insufficiency, Chronic

PURPOSE: Neoadjuvant chemotherapy (NAC) has become the standard treatment for locally advanced breast cancer. The postoperatively adjuvant systemic treatment is based on the status of the histological and biological markers of either the pre-NAC or the post-NAC. There have been several reports that have demonstrated the changes of the histological and biological markers after NAC. The aim of this study is to investigate the effects of NAC on the expression of the histological and biological markers of breast cancer. METHODS: We analyzed the paired pre- and post-NAC tumor specimens from 37 patients with stage IIIA, IIIB or IIIC breast cancer. All the patients received 2 to 6 cycles of anthracycline-containing NAC. Over 6 pieces of pre-NAC tumor specimens were taken by 14 G core needle from multiple sites of a tumor, and the post-NAC specimens were taken at the time of the operation. The histologic grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), c-erbB2, p53, Ki67, CD31 and p-glycoprotein were analyzed in the paired pre- and post-NAC tumor specimens from 37 patients. RESULTS: Twenty five patients (67.6%) revealed significant changes of more than one marker. The markers that showed changes of more than two grades were as follows; histologic grade in 1, ER in 4, PR in 9, c-erbB2 in 4, p53 in 1, Ki67 in 4, CD31 in 9 and pglycoprotein in 5 patients. In 12 patients (32.4%), significant changes were found in the markers that can influence the decision-making for adjuvant treatment (i.e. ER, PR and c-erbB2). The ER/PR status changed from positive to negative in 4 patients and c-erbB2 was changed from positive to negative in 3 patients. Among those patients, the strategy of adjuvant treatment was adjusted according to the changes. CONCLUSION: The specimens for the histologic and biologic markers of a tumor should be taken before NAC because NAC can have an influence on the expression of the prognostic markers of locally advanced breast cancers, and this may subsequently influence predicting the prognosis and making the decision for adjuvant systemic treatment.
Biomarkers ; Breast ; Breast Neoplasms ; Estrogens ; Humans ; Needles ; P-Glycoprotein ; Prognosis ; Receptors, Progesterone

The maintenance of potassium balance depends primarily on excretion by the kidney. The regulated secretion of potassium normally accounts for most of urinary potassium excretion. Potassium transport along the nephron has two main features:the ubiquitous Na,K-ATPase defines basolateral membranes, whereas site-specific potassium transporters are responsible for the apical transport. Two different cell types mediate secretion and reabsorption of potassium. Principal cells secrete potassium, whereas intercalated cells, especially those belonging to the subfamily of beta-intercalated cells, reabsorb potassium. The factors that stimulate potassium secretion by the principal cells include (1) increased extracellular fluid potassium concentration (2) increased aldosterone and (3) increased tubular flow rate. One factor that decreases potassium secretion is increased hydrogen concentration (acidosis). In situations associated with severe potassium depletion, there is a cessation of potassium secretion and net reabsorption of potassium. It is believed that H,K-ATPase transport mechanism located in the luminal membrane of the cortical and outer medullary collecting duct cells reabsorb potassium in exchange for hydrogen secreted into the tubular lumen.
Acidosis ; Aldosterone ; Extracellular Fluid ; Hydrogen ; Kidney* ; Membranes ; Nephrons ; Phenobarbital ; Potassium*